Lisa Marie Gudicello, M.D.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

318455 Issued in NY

Practice address

440 Northern Pkwy
Ridgewood, NJ 07450-1721

Phone

(201) 220-2654

Fax

(201) 220-2654

NPI assigned

Jan 11, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Eye Care Vision Optometry P.C.

  • Optometrist
  • Staten Island, NY
  • NPI 1851983654
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1386794576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 NORTHERN PKWY",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074501721",
            "telephone_number": "201-220-2654",
            "fax_number": "201-220-2654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 NORTHERN PKWY",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074501721",
            "telephone_number": "201-220-2654",
            "fax_number": "201-220-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUDICELLO",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-11",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NJ",
            "license": "MA06926700",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NY",
            "license": "318455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Leigh Grimm, DPT
• Andrey Gritsman, M.D.
• Rita Grogan, MD
• Theresa Kathleen Grueter, LCSW
• Jordan Gruschow
• Guy Guerriero, D.C.
• Guillermo J. Molina, DDS & Associates, LLC
• Samantha Leigh Guillod, APN
• Sanchita Gupta, M.D., MPH
• Linda Gurick, APN-C

• Ophthalmology Physician in Ridgewood, NJ
• Providers in Ridgewood, NJ by specialty
• Ophthalmology Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2023; 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.

Verify at the official NPI Registry.