Takako Komatsuzaki, APN

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

26NJ00706700 Issued in NJ

Practice address

70 Sparta Ave Ste 104
Sparta, NJ 07871-1760

Phone

(973) 726-0697

NPI assigned

Apr 20, 2018

Last updated

Apr 20, 2018By the provider in NPPES

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Live Well Psychology Center LLCGroup PAC ID 5799187928, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Live Well Psychology Center, LLC

  • Psychologist
  • Sparta, NJ
  • NPI 1902459670
  Medicare reassignment Care Compare group NPD
• Newbridge Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Parsippany, NJ
  • NPI 1982768420
  Medicare reassignment
• Newbridge Services, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Wanaque, NJ
  • NPI 1376011585
  NPD

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

{
    "created_epoch": "1524182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524182400000",
    "number": "1700373172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2467 ROUTE 10 BLDG 30-5A",
            "city": "MORRIS PLAINS",
            "state": "NJ",
            "postal_code": "079501349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70 SPARTA AVE STE 104",
            "city": "SPARTA",
            "state": "NJ",
            "postal_code": "078711760",
            "telephone_number": "973-726-0697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMATSUZAKI",
        "first_name": "TAKAKO",
        "name_prefix": "Ms.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-20",
        "last_updated": "2018-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NJ",
            "license": "26NJ00706700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dagmar Kloupar, MD
• Mary Beth Kneis, MSW
• Knoll View Corp
• Jennifer B Koch, PT
• Brian Kokulak, DPT
• Debra E Koss, M.D.
• Kayla Kostecki, LAC
• Stephen Alan Kowalsky, OD
• Shannon Kuratli
• Elizabeth Kussler

• Psychiatric/Mental Health Nurse Practitioner in Sparta, NJ
• Providers in Sparta, NJ by specialty
• Psychiatric/Mental Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; 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.