Individual provider Active NPI

Igor David Nestorowicz, O.D.

  • Optometrist
  • Freehold, NJ
National Provider Identifier
1154427532
Registry record updated Mar 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00607300 Issued in NJ
Practice address
4345 US RT 9 North
Freehold, NJ 07728
Phone
(732) 431-1004
NPI assigned
Sep 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X VUT005869 NY
Optometrist 152W00000X 27OA00607300 NJ Primary

Addresses

Primary practice location

4345 US RT 9 North
Freehold, NJ 07728

Mailing address

4345 US RT 9 North
Freehold, NJ 07728

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070206000158 NJ Practitioner - Optometry 8628070505 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4345 Route 9 N
Freehold, NJ 07728-4215
Phone (732) 431-1004

4345 US 9
Freehold, NJ 07728-4215

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27OA00607300NJMDOptometrist
VUT005869NYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
I. David Nestorowicz L.L.C. Optometrist CurrentSince Apr 1, 2008 Accepting new patients
Empire Vision Center, Inc Past Accepting new patients
Empire Vision Center Inc Optometrist PastSince Aug 9, 2010 Accepting new patients

Locations

4345 US Highway 9
Freehold, NJ 07728
Phone (732) 414-3601

Organizations & group practices 3

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": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206316800000",
    "number": "1154427532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4345 US RT 9 NORTH",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "07728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4345 US RT 9 NORTH",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "07728",
            "telephone_number": "732-431-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NESTOROWICZ",
        "first_name": "IGOR",
        "middle_name": "DAVID",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2008-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT005869",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00607300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freehold, NJ

Sources for this page

Verify at the official NPI Registry.