1. Home
  2. Directory
  3. New Jersey
  4. Union
  5. Physician Assistant
  6. NPI Profile

MALLORY VICEDOMINI PA
NPI 1447070909
Physician Assistant in Union, NJ

Active since October 10, 2024PECOS EnrolledAccepts Medicare Assignment
1057 COMMERCE AVE, UNION, NJ 07083(866) 467-1770 Get Directions Write a Review

NPPES record last updated: November 21, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Nov 21, 2024, Oct 10, 2024 (2 updates tracked since 2024).

About Mallory Vicedomini Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MALLORY VICEDOMINI PA (NPI 1447070909) is an individual physician assistant in Union, New Jersey and active in the NPI registry since October 2024. She is enrolled in Medicare PECOS and is a graduate of Other (2024).

NPPES Registry Identity

NPI1447070909
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMALLORY VICEDOMINICredential: PA
Location Address1057 COMMERCE AVEUnion, NJ 07083-5025
Mailing Address1057 Commerce AveUnion, NJ 07083-5025 · (866) 467-1770
Phone(866) 467-1770
Sole ProprietorNo
Medical School CMSOtherGraduated 2024
Enumeration DateOctober 10, 2024
Last NPPES UpdateNovember 21, 20242 updates tracked since enumeration
NPPES CertifiedNovember 21, 2024
✔ NPI 1447070909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1057 COMMERCE AVE, Union, NJ 07083
Open in Google Maps ↗

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mallory Vicedomini Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5092242016
PECOS Enrollment IDI20250102001399
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 07083 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$98.09 typical visit price
range $63.84 – $190.92
Typical copayment $24.52 (range $15.96 – $47.73)
Most-billed visit code 99203
Established Patient
$79.09 typical visit price
range $20.97 – $155.92
Typical copayment $19.77 (range $5.24 – $38.98)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. ANIL KARUNAKARAN NAIR M.D.
Neurological Surgery
1057 COMMERCE AVE
UNION, NJ 07083
Union County (908) 688-8800
DR. CIRO GIUSEPPE RANDAZZO MD., MPH
Neurological Surgery
1057 COMMERCE AVE
UNION, NJ 07083
Union County (908) 688-8800
DR. DAVID POULAD M.D.
Neurological Surgery
1057 COMMERCE AVE
UNION, NJ 07083
Union County (908) 688-8800
ANTHONY PATRICK DE MARCO PSYD
Clinical Neuropsychologist
1057 COMMERCE AVE
UNION, NJ 07083
Union County (866) 467-1770
CORALIE GUERDAT
Physician Assistant
1057 COMMERCE AVE
UNION, NJ 07083
Union County (908) 688-8800
MICHAEL ANTHONY INGRASSIA
Physician Assistant
1057 COMMERCE AVE
UNION, NJ 07083
Union County (866) 467-1770
JENNA LYNN SANDFORD APN
Nurse Practitioner (Family)
1057 COMMERCE AVE
UNION, NJ 07083
Union County (866) 467-1770
JAKE KOCOVSKY PT, DPT
Physical Therapist
1057 COMMERCE AVE
UNION, NJ 07083
Union County (908) 688-0838

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mallory Vicedomini's NPI number?

The NPI number for Mallory Vicedomini is 1447070909. It was assigned to this individual provider in the NPPES registry on October 10, 2024.

Where is Mallory Vicedomini located?

Mallory Vicedomini practices at 1057 Commerce Ave, Union, NJ 07083. The listed phone number is (866) 467-1770.

What is Mallory Vicedomini's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Mallory Vicedomini enrolled in Medicare?

Yes. Mallory Vicedomini is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Mallory Vicedomini was last updated on November 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.