NPIMap

Individual provider Active NPI

Bernier Lauredan, M.D.

  • Preferred Provider Organization
  • Irvington, NJ
National Provider Identifier
1639283047
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
25MA05388700 Issued in NJ
Practice address
22 Ball St
Suite 100
Irvington, NJ 07111-3521
Phone
(973) 371-1600
Fax
(973) 372-7677
NPI assigned
Aug 19, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 25MA05388700 NJ Primary

Addresses

Primary practice location

22 Ball St
Suite 100
Irvington, NJ 07111-3521

Mailing address

22 Ball St
Suite 100
Irvington, NJ 07111-3521
Phone (973) 371-1600

Other identifiers 1

IdentifierTypeStateIssuer
0677701MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA05388700NJMDPreferred Provider Organization

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639283047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "address_2": "SUITE 100",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600",
            "fax_number": "973-372-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 BALL ST",
            "address_2": "SUITE 100",
            "city": "IRVINGTON",
            "state": "NJ",
            "postal_code": "071113521",
            "telephone_number": "973-371-1600",
            "fax_number": "973-372-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUREDAN",
        "first_name": "BERNIER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "NJ",
            "license": "25MA05388700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0677701",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvington, NJ

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.