Individual provider Active NPI

Maty Youngewirth, OD

  • Optometrist
  • Bergenfield, NJ
National Provider Identifier
1528194560
Registry record updated Mar 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OA005751 Issued in NJ
Practice address
6 Briarcliffe Rd
Bergenfield, NJ 07621-4021
Phone
(917) 548-5083
NPI assigned
Feb 26, 2007
Last updated
Mar 7, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OA005751 NJ Primary

Addresses

Primary practice location

6 Briarcliffe Rd
Bergenfield, NJ 07621-4021

Mailing address

6 Briarcliffe Rd
Bergenfield, NJ 07621-4006
Phone (201) 338-2285

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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116001144 NJ Practitioner - Optometry 4880658186 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

149 Front St
Secaucus, NJ 07094-3463
Phone (201) 348-0800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OA005751NJMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Front Street Eyecare, LLC Optometrist CurrentSince May 11, 2021 Accepting new patients
G & a Optical, Inc. Optometrist Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615075200000",
    "number": "1528194560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 BRIARCLIFFE RD",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076214006",
            "telephone_number": "201-338-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 BRIARCLIFFE RD",
            "city": "BERGENFIELD",
            "state": "NJ",
            "postal_code": "076214021",
            "telephone_number": "917-548-5083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGEWIRTH",
        "first_name": "MATY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2021-03-07",
        "certification_date": "2021-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NJ",
            "license": "OA005751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bergenfield, NJ

Sources for this page

Verify at the official NPI Registry.