Individual provider Active NPI

Yvu Van

  • Plastic Surgery Physician
  • Maywood, NJ
National Provider Identifier
1174056980
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
License
25MA12327200 Issued in NJ
Practice address
113 W Essex St Ste 202
Maywood, NJ 07607-1023
Phone
(201) 845-6363
Fax
(201) 603-1993
NPI assigned
Apr 7, 2017
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X 25MA12327200 NJ Primary
Plastic Surgery Physician 208200000X A184635 CA

Addresses

Primary practice location

113 W Essex St Ste 202
Maywood, NJ 07607-1023

Mailing address

PO Box 626
Great River, NY 11739-0626
Phone (631) 892-2745

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240920000045 NJ Practitioner - Plastic and Reconstructive Surgery 7517204217 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aesthetic and Reconstructive Surgeons, LLCGroup PAC ID 9830114362, 6 clinicians

Practice addresses (Care Compare)

113 Essex St
Lower Level
Maywood, NJ 07607-1020
Phone (201) 291-9100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision18
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A184635CAMDPlastic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aesthetic & Reconstructive Surgeons, LLC Plastic Surgery CurrentSince Sep 1, 2024 Accepting new patients

Locations

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

113 W Essex St
Ste 202
Maywood, NJ 07607
Phone (201) 487-3400

113 W Essex St
Lowr
Maywood, NJ 07607
Phone (201) 291-9100

3500 Sunrise Hwy
Ste 200
Great River, NY 11739
Phone (631) 650-6546

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.

Hospital & facility affiliations 2

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": "1491523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1174056980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 626",
            "city": "GREAT RIVER",
            "state": "NY",
            "postal_code": "117390626",
            "telephone_number": "631-892-2745",
            "fax_number": "631-201-3179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 W ESSEX ST STE 202",
            "city": "MAYWOOD",
            "state": "NJ",
            "postal_code": "076071023",
            "telephone_number": "201-845-6363",
            "fax_number": "201-603-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "YVU",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-07",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NJ",
            "license": "25MA12327200",
            "primary": true
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CA",
            "license": "A184635",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maywood, NJ

Sources for this page

Verify at the official NPI Registry.