Individual provider Active NPI

Robert Richard Vanderyajt, OD

  • Optometrist
  • Hamburg, NJ
National Provider Identifier
1164458154
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00441400 Issued in NJ
Practice address
Plaza 23
225 Route 23
Hamburg, NJ 07419
Phone
(973) 823-0300
Fax
(973) 823-0038
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 27OA00441400 NJ Primary

Addresses

Primary practice location

Plaza 23
225 Route 23
Hamburg, NJ 07419

Mailing address

225 Route 23
Plaza 23
Hamburg, NJ 07419
Phone (973) 823-0300

Other identifiers 1

IdentifierTypeStateIssuer
1916700MedicaidNJ

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
I20110125001118 NJ Practitioner - Optometry 7517146376 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Plaza
23 225 Route 23
Hamburg, NJ 07419-1700
Phone (973) 823-0300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4414NJMDClinical Psychologist
27OA00441400NJMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Robert R Vanderyajt OD PC Optometrist CurrentSince Jan 1, 1989 Accepting new patients

Locations

225 State Rt 23 S
Ste 1B
Hamburg, NJ 07419
Phone (973) 823-0300

Organizations & group practices 1

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": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1164458154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 ROUTE 23",
            "address_2": "PLAZA 23",
            "city": "HAMBURG",
            "state": "NJ",
            "postal_code": "07419",
            "telephone_number": "973-823-0300",
            "fax_number": "973-823-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PLAZA 23",
            "address_2": "225 ROUTE 23",
            "city": "HAMBURG",
            "state": "NJ",
            "postal_code": "07419",
            "telephone_number": "973-823-0300",
            "fax_number": "973-823-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDERYAJT",
        "first_name": "ROBERT",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00441400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1916700",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamburg, NJ

Sources for this page

Verify at the official NPI Registry.