Christine Vivolo, PA
Individual provider Active NPI Surgical Physician Assistant · Paramus, NJ
NPI 1043089576 · NPPES record last updated Dec 26, 2023
Key facts
- NPI
- 1043089576
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgical Physician Assistant 363AS0400X
- License
- 25MP00818000 (NJ)
- Practice address
- 230 E Ridgewood Ave
Paramus, NJ 07652-4142 - Phone
- (201) 597-4130
- NPI assigned
- Dec 26, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Bergen County Improvement Authority
Practice addresses (Care Compare)
230 E Ridgewood Ave
Paramus, NJ 07652-4142
Phone (201) 967-4000
Hospital & facility affiliations
- Bergen New Bridge Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240202003522 | NJ | Practitioner - Physician Assistant | 8628411949 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MP00818000 | NJ | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bergen County Improvement Authority | Current |
Accepting new patients | |
| Bergen County Improvement Authority | Current |
Accepting new patients |
Locations
230 E Ridgewood Ave
Paramus, NJ 07652
Phone (201) 225-4700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | 25MP00818000 | NJ | Yes |
Addresses
Primary practice location
230 E Ridgewood Ave
Paramus, NJ 07652-4142
Mailing address
230 E Ridgewood Ave
Paramus, NJ 07652-4142
Other providers in Paramus, NJ
- Kajal Viradia
- Visage Surgical LLC
- Jack H Vitenson
- Anne Vitiello
- Natalia Vives
- Samantha Grace Voltmer
- Krina A Vyas
- Rushikesh Harishkumar Vyas
- Amanda Wagner
- Jenniffer Wahler
All providers in Paramus, NJ · Surgical Physician Assistant in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 26, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.