Wyckoff Ophthalmology, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

31TD00220800 Issued in NY

Legal business name

WYCKOFF OPHTHALMOLOGY, LLC

Practice address

350 Franklin Ave
Wyckoff, NJ 07481-1909

Phone

(201) 891-7216

NPI assigned

Mar 12, 2008

Organization subpart

No

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

Authorized official

Name

Warren Boardman

Title

Prop

Phone

(201) 445-4808

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Wyckoff Ophthalmology,LLC

  • Ophthalmology Physician
  • Wyckoff, NJ
  • NPI 1619238326

  7618098096

  Same PAC ID

Tax ID family

Wyckoff Ophthalmology LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wyckoff Ophthalmology,LLC

  • Ophthalmology Physician
  • Wyckoff, NJ
  • NPI 1619238326
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyler D'Agostino

  • Optometrist
  • Wyckoff, NJ
  • NPI 1881379568
  NPD
• Melanie A Sinatra, M.D.F.A.C.S.

  • Optometrist
  • Wyckoff, NJ
  • NPI 1043245954
  NPD

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

{
    "created_epoch": "1205280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360540800000",
    "number": "1205007747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 FRANKLIN AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811909",
            "telephone_number": "201-891-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 FRANKLIN AVE",
            "city": "WYCKOFF",
            "state": "NJ",
            "postal_code": "074811909",
            "telephone_number": "201-891-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WYCKOFF OPHTHALMOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-12",
        "last_updated": "2013-02-11",
        "status": "A",
        "authorized_official_last_name": "BOARDMAN",
        "authorized_official_first_name": "WARREN",
        "authorized_official_title_or_position": "PROP",
        "authorized_official_telephone_number": "201-445-4808"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "31TD00220800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tom R Willemann, PT,OCS,MS
• Tiffani Michelle Winfrey
• Wyckoff Dental Associates, LLC
• Wyckoff Dental Spa LLC (Nuva Smile)
• Wyckoff Family YMCA
• Wyckoff Ophthalmology,LLC
• Wyckoff Optical, Inc. (James Tracey Eye Care)
• Wycoff-Nelson (Fyzical Therapy and Balance Centers)
• Mondana Sepahi Yazdi, M.D., F.A.A.P.
• Edward F Younghans, DPM

• Durable Medical Equipment & Medical Supplies in Wyckoff, NJ
• Providers in Wyckoff, NJ by specialty
• Durable Medical Equipment & Medical Supplies in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.