Dr Severiano Fajardo Sanjuan Jr, MD is a medicare enrolled "Pediatrics" physician in Maplewood, New Jersey. His current practice location is
2040 Millburn Ave, Suite 302, Maplewood, New Jersey. You can reach out to his office (for appointments etc.) via phone at
(973) 762-0035.
Dr Severiano Fajardo Sanjuan Jr is licensed to practice in New Jersey (license number MA34053) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1891701595.
Physician's Profile
| Full Name | Dr Severiano Fajardo Sanjuan Jr |
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| Gender | Male |
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| Speciality | Pediatrics |
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| Location | 2040 Millburn Ave, Maplewood, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1891701595
- Provider Enumeration Date: 08/01/2006
- Last Update Date: 12/12/2014
Medicare PECOS Information:
- PECOS PAC ID: 2769859909
- Enrollment ID: I20221101002207
Medical Identifiers
Medical identifiers for Dr Severiano Fajardo Sanjuan Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1891701595 | NPI | - | NPPES |
| 1755901 | Medicaid | NJ | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208000000X | Pediatrics | MA34053 (New Jersey) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Severiano Fajardo Sanjuan Jr allows following entities to bill medicare on his behalf.
| Entity Name | City Of Newark |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1356561278
PECOS PAC ID: 8123169182
Enrollment ID: O20100113000101 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Severiano Fajardo Sanjuan Jr is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Severiano Fajardo Sanjuan Jr, MD
2040 Millburn Ave, Suite 302,
Maplewood, NJ 07040-3726
Ph: (973) 762-0035 | Dr Severiano Fajardo Sanjuan Jr, MD
2040 Millburn Ave, Suite 302,
Maplewood, NJ 07040-3726
Ph: (973) 762-0035 |
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