Jennifer Lyn Vidal, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

25MB08925500 Issued in NJ

Practice address

332 Harrison Ave
Harrison, NJ 07029-1775

Phone

(973) 484-4584

NPI assigned

Jun 12, 2011

Sex

Female

Sole proprietor

No

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.

• Elmer S. David, MD, PLLC

  • Pediatrics Physician
  • Las Vegas, NV
  • NPI 1720324429

  NV, Pediatrics

  Medicare reassignment NPD
• Cooperman Barnabas Medical Center Inc

  • General Acute Care Hospital
  • Livingston, NJ
  • NPI 1396857488
  NPD (past)
• A Las Vegas Pediatrics

  • Primary Care Clinic/Center
  • Las Vegas, NV
  • NPI 1740608108
  NPD (past)
• Henderson Hospital

  • General Acute Care Hospital
  • Henderson, NV
  • NPI 1003281452
  NPD (past)
• Sunrise Hospital and Medical Center, LLC

  • General Acute Care Hospital
  • Las Vegas, NV
  • NPI 1861439952
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in NV

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

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4
• Direct secure messaging: jennifer.vidal.2@17181.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 16, 2011.

{
    "created_epoch": "1307836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308182400000",
    "number": "1649565201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 N 16TH ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070035828",
            "telephone_number": "973-429-9112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 HARRISON AVE",
            "city": "HARRISON",
            "state": "NJ",
            "postal_code": "070291775",
            "telephone_number": "973-484-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDAL",
        "first_name": "JENNIFER",
        "middle_name": "LYN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-12",
        "last_updated": "2011-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MB08925500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Kinhsing Tsai, L.AC.
• Megan Marie Ulrey, RN, IBCLC
• Shushma Upadhayay
• Pooja M Vekaria, PHARMD
• Elba Catalina Ventura, DENTIST DDS
• Walgreen Co
• Walgreen Co
• Walgreen Co
• Walter Perez, M.D., L.L.C.
• Wellness Supermarket & Pharmacy

• All providers in Harrison, NJ
• Pediatrics Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2011; 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.