Individual provider Active NPI

Advaith Bongu, MD

  • Surgery Physician
  • New York, NY
National Provider Identifier
1356577035
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
25MA09499200 Issued in NJ
Practice address
622 W 168TH St
New York, NY 10032-3720
Phone
(212) 305-0914
Fax
(212) 305-4343
NPI assigned
Jun 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Transplant Surgery Physician 204F00000X 283949 NY
Surgery Physician 208600000X 25MA09499200 NJ Primary
Transplant Surgery Physician 204F00000X 25MA09499200 NJ

Addresses

Primary practice location

622 W 168TH St
New York, NY 10032-3720

Mailing address

622 W 168TH St
New York, NY 10032-3720
Phone (212) 305-0914

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
I20181207000055 NJ Practitioner - General Surgery 0143515072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Rutgers New Jersey Medical School, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rutgers Health-RWJ Neurosurgery FacultyGroup PAC ID 4587613443, 189 clinicians

Practice addresses (Care Compare)

10 Plum St
New Brunswick, NJ 08901-2065
Phone (732) 235-6333

Hospital & facility affiliations

  • Visiting Nurse Association of Central Jersey Home Care and Hospice Home health agency, Toms River, NJ, CCN 317067
  • Robert Wood Johnson University Hospital Hospital, New Brunswick, NJ, CCN 310038

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
283949NYMDTransplant Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rutgers Health-RWJ Neurosurgery Faculty CurrentSince Dec 19, 2022 Accepting new patients
Robert Wood Johnson Medical Associates CurrentSince Oct 2, 2018 Accepting new patients
Rutgers Health-RWJ Neurosurgery Faculty Current Accepting new patients
Rutgers Health-RWJ Neurosurgery Faculty Surgery CurrentSince Dec 19, 2022 Accepting new patients
Robert Wood Johnson University Hospital, Inc Past Accepting new patients

Locations

10 Plum St
New Brunswick, NJ 08901
Phone (732) 235-6333

1 Rwj Pl
New Brunswick, NJ 08901
Phone (732) 235-7887

10 Plum St
Fl 7
New Brunswick, NJ 08901
Phone (732) 253-3360

125 Paterson St
Ste 4100
New Brunswick, NJ 08901
Phone (732) 235-7756

Interoperability endpoints

  • Direct secure messaging: abongu14970@epicdirect.rwjbh.org

Organizations & group practices 5

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": "1244419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782432000000",
    "number": "1356577035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-0914",
            "fax_number": "212-305-4343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W 168TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323720",
            "telephone_number": "212-305-0914",
            "fax_number": "212-305-4343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONGU",
        "first_name": "ADVAITH",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-08",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NY",
            "license": "283949",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NJ",
            "license": "25MA09499200",
            "primary": true
        },
        {
            "code": "204F00000X",
            "taxonomy_group": "",
            "desc": "Transplant Surgery",
            "state": "NJ",
            "license": "25MA09499200",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.