Active NPI
Kathleen M. Cerkvenik, MD
- Pediatrics Physician
- Wyckoff, NJ
National Provider Identifier
1740249671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MA042021
- Practice address
- 541 Cedar Hill Ave
Wyckoff, NJ 07481-2150 - Phone
- (201) 652-0300
- Fax
- (201) 444-6209
- NPI assigned
- Mar 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MA042021 | NJ | Primary |
Addresses
Primary practice location
541 Cedar Hill Ave
Wyckoff, NJ 07481-2150
Mailing address
541 Cedar Hill Avenue
Wyckoff, NJ 07481-2150
Phone (201) 445-4630
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 222110646 | Other | NJ | BUSINESS TAX ID # |
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: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160224001141 | NJ | Order and Referring Only - Pediatric Medicine | 6305141664 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333584000000",
"number": "1740249671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "541 CEDAR HILL AVENUE",
"city": "WYCKOFF",
"state": "NJ",
"postal_code": "074812150",
"telephone_number": "201-445-4630",
"fax_number": "201-444-6209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "541 CEDAR HILL AVE",
"city": "WYCKOFF",
"state": "NJ",
"postal_code": "074812150",
"telephone_number": "201-652-0300",
"fax_number": "201-444-6209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CERKVENIK",
"first_name": "KATHLEEN",
"middle_name": "M.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-20",
"last_updated": "2012-04-05",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "MA042021",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BUSINESS TAX ID #",
"identifier": "222110646",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wyckoff, NJ
- Ronald N Cauchard, OD
- Angela Cays, LPC
- Cedar Hill Obstetrical & Gynecological Assoc PA
- Cedar Hill Obstetrics & Gynecology Associates,PA
- Center for Remote Medical Management LLC
- Julie Yuet Nor Chan
- Dianne D Chase, COTA
- Cheryl Schrader, LLC
- Chiropractic Wellness Center of Wyckoff Inc
- Joseph Charles Christ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.