NPIMap

Individual provider Active NPI

Jillian Nicole Uzdzinski, DO

  • Family Medicine Physician
  • Brodheadsville, PA
National Provider Identifier
1124511944
Registry record updated Aug 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS021404 Issued in PA
Practice address
120 Burrus Blvd Ste 200
Brodheadsville, PA 18322-7812
Phone
(570) 420-6300
NPI assigned
Jun 7, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X OS021404 PA Primary

Addresses

Primary practice location

120 Burrus Blvd Ste 200
Brodheadsville, PA 18322-7812

Mailing address

220 Rowan Blvd Apt 620
Glassboro, NJ 08028-2275
Phone (267) 658-0204

Other practice location 1

1505 W Sherman Ave
Vineland, NJ 08360-7059
Phone (856) 641-8000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210924000634 PA Practitioner - Family Practice 6406253012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rowan University School of Osteopathic Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1210 S Cedar Crest Blvd
Allentown, PA 18103-6235
Phone (610) 402-3888

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Physician Group CurrentSince Sep 7, 2021 Accepting new patients
Lehigh Valley Physician Group Family Medicine Current Accepting new patients
Lehigh Valley Physician Group Family Medicine CurrentSince Sep 7, 2021 Accepting new patients

Locations

2100 Mack Blvd
Allentown, PA 18103
Phone (484) 224-1892

120 Burrus Blvd
Ste 200
Brodheadsville, PA 18322
Phone (570) 420-6300

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

Interoperability endpoints

  • Direct secure messaging: juzdzinski589396@direct2.lvhn.org

Organizations & group practices 4

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 8

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": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628035200000",
    "number": "1124511944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 ROWAN BLVD APT 620",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080282275",
            "telephone_number": "267-658-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BURRUS BLVD STE 200",
            "city": "BRODHEADSVILLE",
            "state": "PA",
            "postal_code": "183227812",
            "telephone_number": "570-420-6300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1505 W Sherman Ave",
            "address_purpose": "LOCATION",
            "city": "Vineland",
            "state": "NJ",
            "postal_code": "083607059",
            "country_code": "US",
            "telephone_number": "856-641-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "UZDZINSKI",
        "first_name": "JILLIAN",
        "middle_name": "NICOLE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-06-07",
        "last_updated": "2021-08-04",
        "certification_date": "2021-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "OS021404",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brodheadsville, PA

Sources for this page

Verify at the official NPI Registry.