Individual provider Active NPI

Inna Zimmerling, OD

  • Optometrist
  • North Bergen, NJ
National Provider Identifier
1376579060
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
27OA00584700 Issued in NJ
Practice address
7733 Bergenline Ave
North Bergen, NJ 07047-7134
Phone
(201) 868-1021
Fax
(201) 868-2960
NPI assigned
Jun 24, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 27OA00584700 NJ Primary
Optometrist 152W00000X 1245 NJ
Optometrist 152W00000X 006841 NY
Corneal and Contact Management Optometrist 152WC0802X 27OA00584700 NJ
Optometrist 152W00000X TUV00684100 NY

Addresses

Primary practice location

7733 Bergenline Ave
North Bergen, NJ 07047-7134

Mailing address

538 Undercliff Ave
Unit B
Edgewater, NJ 07020-1310
Phone (201) 218-4485

Other practice location 1

12102 Liberty Ave
South Richmond Hill, NY 11419-2112
Phone (718) 835-3400

Other practice location 2

16 E Prospect St
Waldwick, NJ 07463-2008
Phone (902) 290-6933

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050811000110 NJ Practitioner - Optometry 4385673284 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1245NJMDOptometrist
27OA00584700NJMDOptometrist
TUV00684100NYMDOptometrist
006841NYMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
New Jersey Refractive Professional Corporation Optometrist Past Accepting new patients
Modern Vision, Inc Optometrist Past Accepting new patients
Greenwich Eye Center Corneal and Contact Management Past Accepting new patients

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1376579060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 UNDERCLIFF AVE",
            "address_2": "UNIT B",
            "city": "EDGEWATER",
            "state": "NJ",
            "postal_code": "070201310",
            "telephone_number": "201-218-4485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7733 BERGENLINE AVE",
            "city": "NORTH BERGEN",
            "state": "NJ",
            "postal_code": "070477134",
            "telephone_number": "201-868-1021",
            "fax_number": "201-868-2960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12102 Liberty Ave",
            "address_purpose": "LOCATION",
            "city": "South Richmond Hill",
            "state": "NY",
            "postal_code": "114192112",
            "country_code": "US",
            "telephone_number": "718-835-3400",
            "fax_number": "718-835-3900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "16 E Prospect St",
            "address_purpose": "LOCATION",
            "city": "Waldwick",
            "state": "NJ",
            "postal_code": "074632008",
            "country_code": "US",
            "telephone_number": "902-290-6933",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZIMMERLING",
        "first_name": "INNA",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "27OA00584700",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "1245",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "006841",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "NJ",
            "license": "27OA00584700",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV00684100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Bergen, NJ

Sources for this page

Verify at the official NPI Registry.