NPIMap

Individual provider Active NPI

Matin Mikayil Imanguli, MD, DDS

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Edison, NJ
National Provider Identifier
1114065406
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X
License
25MA10294300 Issued in NJ
Practice address
102 James St Ste 302
Edison, NJ 08820-3970
Phone
(732) 635-9300
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 0401411071 VA
Otolaryngology Physician 207Y00000X Q0461 TX
Otolaryngology Physician 207Y00000X 36041 AL
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X 25MA10294300 NJ
Plastic Surgery within the Head & Neck (Otolaryngology) Physician 207YX0007X 25MA10294300 NJ Primary

Addresses

Primary practice location

102 James St Ste 302
Edison, NJ 08820-3970

Mailing address

3600 Route 66 FL 3
Neptune, NJ 07753-2645
Phone (732) 807-0877

Other identifiers 3

IdentifierTypeStateIssuer
542034392OtherVATAX IDENTIFICATION
113660124OtherVATAX IDENTIFICATION
841629676OtherVATAX IDENTIFICATION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, NJ2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170928002895 AL Practitioner - Otolaryngology 7618242710 Reassigns benefits to 1 organization
I20180521000302 NJ Practitioner - Otolaryngology 7618242710 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
University of Chicago, Pritzker School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hackensack Meridian Health Medical Group - Specialty Care PCGroup PAC ID 9133032519, 1,901 clinicians

Practice addresses (Care Compare)

102 James St
Suite 303
Edison, NJ 08820-3970
Phone (848) 205-2620

Hospital & facility affiliations

  • JFK University Medical Center Hospital, Edison, NJ, CCN 310108
  • Jersey Shore University Medical Center Hospital, Neptune, NJ, CCN 310073
  • Raritan Bay Medical Center Hospital, Perth Amboy, NJ, CCN 310039

Merit-based Incentive Payment System (MIPS)

Final score
81.33 of 100Reported as group
Quality
66.38
Promoting interoperability
100
Improvement activities
40
Cost
71.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0401411071VAMDDentist
36041ALMDOtolaryngology Physician
25MA10294300NJMDOtolaryngology Physician
Q0461TXMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hackensack Meridian Health Medical Group - Specialty Care PC Dentist CurrentSince Jun 28, 2023 Accepting new patients
University of Alabama Health Services Foundation, PC. Single Specialty CurrentSince Jul 25, 2017 Accepting new patients
Rutgers Health-RWJ Neurosurgery Faculty Single Specialty Current Accepting new patients
Hackensack Meridian Health Medical Group - Specialty Care PC Single Specialty CurrentSince Jun 28, 2023 Accepting new patients
Rutgers Health-RWJ Neurosurgery Faculty CurrentSince Jul 1, 2018 Accepting new patients
Rutgers Health-RWJ Neurosurgery Faculty Single Specialty CurrentSince Jul 1, 2018 Accepting new patients
Hackensack Meridian Health Medical Group - Complex Care PC Single Specialty Past Accepting new patients

Locations

619 19th St S
Birmingham, AL 35249

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

1808 7th Ave S
Birmingham, AL 35233
Phone (205) 934-2003

102 James St
Ste 303
Edison, NJ 08820
Phone (848) 205-2620

80 James St
Fl 2
Edison, NJ 08820
Phone (732) 635-9300

30 Prospect Ave
Hackensack, NJ 07601
Phone (201) 488-0066

3600 State Route 66
Fl 3
Neptune City, NJ 07753
Phone (732) 807-0463

10 Plum St
New Brunswick, NJ 08901
Phone (732) 235-6333

125 Paterson St
Ste 4100
New Brunswick, NJ 08901
Phone (732) 235-7756

Interoperability endpoints

  • Direct secure messaging: matin.imanguli@direct.hackensackmeridian.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Organizations & group practices 7

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702339200000",
    "number": "1114065406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 ROUTE 66 FL 3",
            "city": "NEPTUNE",
            "state": "NJ",
            "postal_code": "077532645",
            "telephone_number": "732-807-0877",
            "fax_number": "201-751-1680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 JAMES ST STE 302",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088203970",
            "telephone_number": "732-635-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMANGULI",
        "first_name": "MATIN",
        "middle_name": "MIKAYIL",
        "name_prefix": "Dr.",
        "credential": "MD, DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401411071",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "Q0461",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "AL",
            "license": "36041",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "NJ",
            "license": "25MA10294300",
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "NJ",
            "license": "25MA10294300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "542034392",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "113660124",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX IDENTIFICATION",
            "identifier": "841629676",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edison, NJ

Sources for this page

Verify at the official NPI Registry.