Individual provider Active NPI

Vody Elaine Vincent

  • Psychiatric/Mental Health Nurse Practitioner
  • Union, NJ
National Provider Identifier
1013059575
Registry record updated Oct 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
26NJ01343900 Issued in NJ
Practice address
2742 Alice Ter
Union, NJ 07083-4103
Phone
(908) 708-3618
Fax
(862) 205-2477
NPI assigned
Feb 13, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 26NJ01343900 NJ Primary
Registered Nurse 163W00000X 26NO11343600 NJ

Addresses

Primary practice location

2742 Alice Ter
Union, NJ 07083-4103

Mailing address

2742 Alice Ter
Union, NJ 07083-4103
Phone (908) 708-3618

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221104000976 NJ Practitioner - Nurse Practitioner 2163899196 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2115 Millburn Ave
Maplewood, NJ 07040-3724
Phone (908) 708-3618

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NO11343600NJMDRegistered Nurse
26NJ01343900NJMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regeneration Behavioral Health Care Psychiatric/Mental Health CurrentSince Sep 30, 2024 Accepting new patients

Locations

2115 Millburn Ave
Maplewood, NJ 07040
Phone (973) 592-1512

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698019200000",
    "number": "1013059575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2742 ALICE TER",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070834103",
            "telephone_number": "908-708-3618",
            "fax_number": "862-205-2477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2742 ALICE TER",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070834103",
            "telephone_number": "908-708-3618",
            "fax_number": "862-205-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "VODY",
        "middle_name": "ELAINE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2023-10-23",
        "certification_date": "2023-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ01343900",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NO11343600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, NJ

Sources for this page

Verify at the official NPI Registry.