Ketan Harshadray Kutlerywala, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

7391 Issued in NY

Practice address

63 W Pleasant Ave
Maywood, NJ 07607-1334

Phone

(201) 845-4700

NPI assigned

Aug 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

International American University at Puerto Rico - School of Optometry, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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.

• Innovision Optometry NJ PC

  • Optometrist
  • Maywood, NJ
  • NPI 1922608728
  NPD Authorized official

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603929600000",
    "number": "1497861033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 WINDSOR HWY",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125536908",
            "telephone_number": "845-541-9689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 W PLEASANT AVE",
            "city": "MAYWOOD",
            "state": "NJ",
            "postal_code": "076071334",
            "telephone_number": "201-845-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTLERYWALA",
        "first_name": "KETAN",
        "middle_name": "HARSHADRAY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-10-29",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "270A00699500",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "6818T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "7391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keystone Internal Medicine and Weight Loss Center LLC
• Baron Kim
• Michael Kim
• Richard Kim, MD
• Stephanie Konrad, DNP, PMHNP
• Minsun Lee, PH.D.
• Suho Lee, DDS
• Kevin Leithauser, PT, DPT
• Leo Wellness LLC
• Martha Lewycky, DMD

• Optometrist in Maywood, NJ
• Providers in Maywood, NJ by specialty
• Optometrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2020; 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.
• 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.