Prodigy Aesthetics

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

Legal business name

PRODIGY AESTHETICS

Practice address

680 Broadway Ste 205
Paterson, NJ 07514-1527

Phone

(973) 790-0123

NPI assigned

Feb 8, 2023

Organization subpart

No

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

Authorized official

Name

Carolyn Cedeno, APRN

Title

Owner

Phone

(973) 221-5527

Specialties & licenses 1

Addresses

Other names 1

• Prodigy Aesthetics and Primary Care Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1675814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678233600000",
    "number": "1437856648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 BROADWAY STE 205",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141527",
            "telephone_number": "973-790-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 BROADWAY STE 205",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141527",
            "telephone_number": "973-790-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGY AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-08",
        "last_updated": "2023-03-08",
        "certification_date": "2023-03-08",
        "status": "A",
        "authorized_official_last_name": "CEDENO",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-221-5527",
        "authorized_official_credential": "APRN"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prodigy Aesthetics and Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Nurse Practitioner in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Primary Care Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.