Individual provider Active NPI

Watutantrige Takshan Dealwis, M.D.

  • Child & Adolescent Psychiatry Physician
  • Ridgewood, NJ
National Provider Identifier
1396798120
Registry record updated Nov 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
25MA04286900 Issued in NJ
Practice address
223 N Van Dien Ave
Ridgewood, NJ 07450-2726
Phone
(201) 447-8586
Fax
(201) 447-8491
NPI assigned
May 19, 2006
Last updated
Nov 15, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 25MA04286900 NJ Primary

Addresses

Primary practice location

223 N Van Dien Ave
Ridgewood, NJ 07450-2726

Mailing address

71 Berkely Place
Alpine, NJ 07620
Phone (201) 750-1907

Other identifiers 1

IdentifierTypeStateIssuer
6358900MedicaidNJ

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
I20131101000946 NJ Practitioner - Psychiatry 9830324698 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Physician Services PCGroup PAC ID 3577857333, 593 clinicians

Practice addresses (Care Compare)

108 Jackson St
Apt 6B
Hoboken, NJ 07030-6101
Phone (800) 825-5391

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.05 of 100Reported as apm
Quality
85.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Physician Services PC CurrentSince Oct 1, 2016 Accepting new patients

Locations

1 Valley Health Plz
Paramus, NJ 07652
Phone (201) 634-5353

223 N Van Dien Ave
Ridgewood, NJ 07450
Phone (201) 447-8417

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1396798120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "71 BERKELY PLACE",
            "city": "ALPINE",
            "state": "NJ",
            "postal_code": "07620",
            "telephone_number": "201-750-1907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N VAN DIEN AVE",
            "city": "RIDGEWOOD",
            "state": "NJ",
            "postal_code": "074502726",
            "telephone_number": "201-447-8586",
            "fax_number": "201-447-8491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEALWIS",
        "first_name": "WATUTANTRIGE",
        "middle_name": "TAKSHAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NJ",
            "license": "25MA04286900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6358900",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ridgewood, NJ

Sources for this page

Verify at the official NPI Registry.