NPIMap

Individual provider Active NPI

Ellen Vitievsky

  • Internal Medicine Physician
  • West New York, NJ
National Provider Identifier
1366547135
Registry record updated Feb 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA07786200 Issued in NJ
Practice address
5600 Kennedy Blvd W
Suite 102
West New York, NJ 07093-1256
Phone
(201) 866-3100
Fax
(201) 866-0321
NPI assigned
Sep 14, 2006
Last updated
Feb 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA07786200 NJ Primary

Addresses

Primary practice location

5600 Kennedy Blvd W
Suite 102
West New York, NJ 07093-1256

Mailing address

PO Box 7664
North Brunswick, NJ 08902-7664
Phone (201) 866-3100

Other identifiers 1

IdentifierTypeStateIssuer
0076937MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050124000849 NJ Practitioner - Internal Medicine 7315905270 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sciometrix IncGroup PAC ID 9335511443, 46 clinicians
Integrated Healthcare Group, P.C.Group PAC ID 8123054855, 2 clinicians

Practice addresses (Care Compare)

5600 John Fitzgerald Kennedy Blvd
West New York, NJ 07093-3529
Phone (860) 335-5064

5600 Kennedy Blvd
West New York, NJ 07093-1258
Phone (201) 866-3100

Hospital & facility affiliations

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
25MA07786200NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sciometrix Inc CurrentSince Feb 1, 2024 Accepting new patients
Integrated Healthcare Group, P.C. Internal Medicine CurrentSince Sep 1, 2004 Accepting new patients
Sciometrix LLC PastSince Oct 10, 2021 Accepting new patients

Locations

306 S Washington Ave
Ste 600
Royal Oak, MI 48067

5600 Kennedy Blvd E
West New York, NJ 07093

5600 Kennedy Blvd W
West New York, NJ 07093
Phone (201) 686-3100

5600 Kennedy Blvd W
Ste 102
West New York, NJ 07093
Phone (201) 564-7515

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739664000000",
    "number": "1366547135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7664",
            "city": "NORTH BRUNSWICK",
            "state": "NJ",
            "postal_code": "089027664",
            "telephone_number": "201-866-3100",
            "fax_number": "201-866-0321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5600 KENNEDY BLVD W",
            "address_2": "SUITE 102",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070931256",
            "telephone_number": "201-866-3100",
            "fax_number": "201-866-0321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VITIEVSKY",
        "first_name": "ELLEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2025-02-16",
        "certification_date": "2025-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA07786200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0076937",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West New York, NJ

Sources for this page

Verify at the official NPI Registry.