Individual provider Active NPI

Rachel Gwertzman, DO

  • Pediatrics Physician
  • Lakewood, NJ
National Provider Identifier
1740696996
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MB09899700 Issued in NJ
Practice address
1771 Madison Ave
Lakewood, NJ 08701-1251
Phone
(732) 364-2144
NPI assigned
Jul 9, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MB09899700 NJ Primary

Addresses

Primary practice location

1771 Madison Ave
Lakewood, NJ 08701-1251

Mailing address

1771 Madison Ave
Lakewood, NJ 08701-1251

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160907000952 NJ Practitioner - Pediatric Medicine 6406142132 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Lakewood Resource and Referral Center, Inc. CurrentSince Sep 1, 2016 Accepting new patients
Lakewood Resource and Referral Center, Inc. CurrentSince Sep 1, 2016 Accepting new patients
Lakewood Resource and Referral Center Inc Current Accepting new patients
Practice Associates Medical Group Pediatrics CurrentSince Nov 1, 2021 Accepting new patients

Locations

1771 Madison Ave
Lakewood, NJ 08701
Phone (732) 364-2144

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

451 Terrill Rd
Plainfield, NJ 07062
Phone (908) 941-9494

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1404864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1740696996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1771 MADISON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087011251",
            "telephone_number": "732-364-2144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWERTZMAN",
        "first_name": "RACHEL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-09",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MB09899700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, NJ

Sources for this page

Verify at the official NPI Registry.