Active NPI
Jacob Widroff, M.D.
- Psychiatry Physician
- Cinnaminson, NJ
National Provider Identifier
1376764928
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MT187253
- Practice address
- 1803 Jason Dr
Cinnaminson, NJ 08077-1553 - Phone
- (914) 582-6218
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MT187253 | PA | Primary |
Addresses
Primary practice location
1803 Jason Dr
Cinnaminson, NJ 08077-1553
Mailing address
1803 Jason Dr
Cinnaminson, NJ 08077-1553
Phone (914) 582-6218
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102236820 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT187253 | PA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boulevard Anesthesia Associates, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Elmhurst, NY
- NPI 1295770196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328400000000",
"number": "1376764928",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1803 JASON DR",
"city": "CINNAMINSON",
"state": "NJ",
"postal_code": "080771553",
"telephone_number": "914-582-6218"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1803 JASON DR",
"city": "CINNAMINSON",
"state": "NJ",
"postal_code": "080771553",
"telephone_number": "914-582-6218"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDROFF",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2012-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "MT187253",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102236820",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cinnaminson, NJ
- Robert J Voorhees, LPC
- Joseph Wadas IV, O.D.
- Wal-Mart Store East, LP (Walmart Vision Center 30-2871)
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2871)
- Debra Weissbach, MD
- Wikare Health Clinic Inc.
- Lisa N Wilkins-Blount, MA
- William Yee Optometric Services LLC (Apex Vision Eye Care)
- Courtney Genene Winterholler, PA - C
- Shahnaz Toossi Winters, RPH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.