Nana Yenukashvili

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MA08225400 Issued in NJ

Practice address

300 Winston Dr Apt 2911
Cliffside Park, NJ 07010-3232

Phone

(201) 224-5755

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: nyenukashvili77220@direct.optum.com

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.

• New Jersey Medical and Health Associates,LLC

  • Internal Medicine Physician
  • Hoboken, NJ
  • NPI 1558673582
  Medicare reassignment NPD

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1447460712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 WINSTON DR APT 2911",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070103232",
            "telephone_number": "201-224-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WINSTON DR APT 2911",
            "city": "CLIFFSIDE PARK",
            "state": "NJ",
            "postal_code": "070103232",
            "telephone_number": "201-224-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YENUKASHVILI",
        "first_name": "NANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA08225400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Qian Xu, MD
• Qingyang Xu, LMSW
• Geraldine Yalong
• Donghyun Yang, RPH
• Yas Help Services
• Steven Jaekyoung Yeun, PT,DPT
• You Are Not Alone Veterans Foundation Inc
• Solhee Yu

• Pediatrics Physician in Cliffside Park, NJ
• Providers in Cliffside Park, NJ by specialty
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.