Individual provider Active NPI

Richard Gjertsen, PH.D.

  • Psychologist
  • Metuchen, NJ
National Provider Identifier
1033292495
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
2870 Issued in NJ
Practice address
247 Main St
Metuchen, NJ 08840-2727
Phone
(732) 549-7272
NPI assigned
Oct 21, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2870 NJ Primary

Addresses

Primary practice location

247 Main St
Metuchen, NJ 08840-2727

Mailing address

PO Box 1564
Hightstown, NJ 08520-8864
Phone (732) 549-7272

Other identifiers 1

IdentifierTypeStateIssuer
0090476MedicaidNJ

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050523000921 NJ Practitioner - Clinical Psychologist 1456393206 Practice locations: Metuchen, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

20 Highland Ave
Metuchen, NJ 08840-1949
Phone (732) 549-7272

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2870NJMDPsychologist

NPI Registry JSON

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

{
    "created_epoch": "1161388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1033292495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1564",
            "city": "HIGHTSTOWN",
            "state": "NJ",
            "postal_code": "085208864",
            "telephone_number": "732-549-7272",
            "fax_number": "609-426-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 MAIN ST",
            "city": "METUCHEN",
            "state": "NJ",
            "postal_code": "088402727",
            "telephone_number": "732-549-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GJERTSEN",
        "first_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "2870",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0090476",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Metuchen, NJ

Sources for this page

Verify at the official NPI Registry.