Individual provider Active NPI

Elizabeth Mathew, MD

  • Pediatrics Physician
  • Brooklyn, NY
National Provider Identifier
1265819569
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA10237800 Issued in NJ
Practice address
121 Dekalb Ave
Brooklyn, NY 11201
Phone
(718) 250-6277
NPI assigned
May 6, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

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
Pediatrics Physician 208000000X 25MA10237800 NJ Primary

Addresses

Primary practice location

121 Dekalb Ave
Brooklyn, NY 11201

Mailing address

121 Dekalb Ave
Brooklyn, NY 11201-5425
Phone (718) 250-6277

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
I20180208000090 NJ Practitioner - Pediatric Medicine 2668732843 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care of New Jersey PC Pediatrics CurrentSince Jan 1, 2018 Accepting new patients
Optum Medical Care of New Jersey PC CurrentSince Jan 1, 2018 Accepting new patients
Riverside Medical Group Past Accepting new patients
Jersey City Medical Center Past Accepting new patients

Locations

506 Broadway
Bayonne, NJ 07002
Phone (201) 471-7012

935 River Rd
Ste 301
Edgewater, NJ 07020
Phone (201) 471-7012

38 Meadowlands Pkwy
Ste 205
Secaucus, NJ 07094
Phone (201) 552-2357

3403 S Delsea Dr
Vineland, NJ 08360
Phone (856) 293-6974

Interoperability endpoints

  • Direct secure messaging: emathew77119@direct.optum.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1430870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528329600000",
    "number": "1265819569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112015425",
            "telephone_number": "718-250-6277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 DEKALB AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11201",
            "telephone_number": "718-250-6277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATHEW",
        "first_name": "ELIZABETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-06",
        "last_updated": "2018-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA10237800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.