DR. MAVIS CAMALITA ERMAKOV R.D. RN. CDE. APN NPI 1265614911

NPI Information

NPI: 1265614911
Provider Name: DR. MAVIS CAMALITA ERMAKOV, R.D., RN., CDE., APN
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
741 BROADWAY
NEWARK, NJ
ZIP 07104
Phone: (973) 483-1300
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DR. Mavis Camalita Ermakov, R.D., RN., CDE., APN is a family nurse practitioner in Newark, NJ. DR. Mavis Camalita Ermakov, R.D., RN., CDE., APN NPI is 1265614911. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

741 BROADWAY
NEWARK, NJ
ZIP 07104-309
Phone: (973) 483-1300

The NPI 1265614911 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 12/4/2007 and was last updated on 8/17/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	26NJ00421400	NEW JERSEY	Yes
2	133V00000X	Dietitian, Registered		0071705	ILLINOIS	No
3	133VN1006X	Dietitian, Registered	Nutrition, Metabolic	717052 (ID#)	ILLINOIS	No
4	163WD0400X	Registered Nurse	Diabetes Educator	26NR112011600	NEW JERSEY	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	0143533620	MEDICAID	NEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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