Active NPI
Yurata Gerwel Modzelewski, MD
- Pediatrics Physician
- Boonton TWP, NJ
National Provider Identifier
1275796286
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA03879000
- Practice address
- 105 Powerville Road
Boonton TWP, NJ 07005 - Phone
- (973) 299-2903
- Fax
- (973) 299-2903
- NPI assigned
- Jul 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA03879000 | NJ | Primary |
Addresses
Primary practice location
105 Powerville Road
Boonton TWP, NJ 07005
Mailing address
105 Powerville Road
Boonton TWP, NJ 07005
Phone (973) 299-2903
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215561600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215561600000",
"number": "1275796286",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 POWERVILLE ROAD",
"city": "BOONTON TWP",
"state": "NJ",
"postal_code": "07005",
"telephone_number": "973-299-2903",
"fax_number": "973-299-2903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 POWERVILLE ROAD",
"city": "BOONTON TWP",
"state": "NJ",
"postal_code": "07005",
"telephone_number": "973-299-2903",
"fax_number": "973-299-2903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODZELEWSKI",
"first_name": "YURATA",
"middle_name": "GERWEL",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-07-09",
"last_updated": "2008-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA03879000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boonton TWP, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.