Ujjwal Kumar Datta, DPM
Individual provider Active NPI Foot Surgery Podiatrist · Bound Brook, NJ
NPI 1760486385 · NPPES record last updated May 3, 2012
Key facts
- NPI
- 1760486385
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Foot Surgery Podiatrist 213ES0131X
- License
- 25MD00275800 (NJ)
- Practice address
- 4 E High St
Bound Brook, NJ 08805-1946 - Phone
- (732) 537-9200
- Fax
- (732) 356-3750
- NPI assigned
- Jun 10, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 8
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Podiatry
- Education
- New York College of Podiatric Medicine, 2000
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Central Jersey Medical Center Inc.
Practice addresses (Care Compare)
275 Hobart St
Perth Amboy, NJ 08861-3396
4 E High St
Bound Brook, NJ 08805-1946
Phone (732) 537-9200
80 Johnson Ave
Newark, NJ 07108-2729
Phone (973) 623-8592
Hospital & facility affiliations
- Raritan Bay Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of tissue | 1-10 |
| Removal of nail tissue | 30 |
| Removal or shaving of skin growth | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040512000040 | NJ | Practitioner - Podiatry | 4486641800 |
Reassigns benefits to 3 organizations Practice locations: Bound Brook, NJ; Perth Amboy, NJ |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Jersey Medical Center, Inc | Current |
Accepting new patients | |
| Central Jersey Medical Center, Inc. | Current |
Accepting new patients | |
| Monmouth Family Health Center, Inc | Current |
Accepting new patients | |
| Garden State Podiatry, LLC | Current |
Accepting new patients | |
| Monmouth Family Health Center, Inc | Current |
Accepting new patients |
Locations
4 E High St
Bound Brook, NJ 08805
Phone (732) 356-8100
270 Broadway
Long Branch, NJ 07740
Phone (732) 923-7100
80 Johnson Ave
Newark, NJ 07108
Phone (973) 623-8592
275 Hobart St
Perth Amboy, NJ 08861
Phone (732) 376-6635
Interoperability endpoints
- ujjwal.datta.1@16647.direct.athenahealth.com
- https://fhir.meditouchehr.com/api/fhir/r4/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot Surgery Podiatrist | 213ES0131X | 25MD00275800 | NJ | Yes |
Addresses
Primary practice location
4 E High St
Bound Brook, NJ 08805-1946
Mailing address
4 E High St
Bound Brook, NJ 08805-1946
Phone (732) 537-9200
Other providers in Bound Brook, NJ
- Marjorie Cote
- Ari Crystal-Ornelas
- Matthew Edison Cumber
- Evan Curry
- Jeffrey C Danco
- Delta Community Supports, Inc.
- Delta Community Supports, Inc.
- Delta Community Supports, Inc.
- Delta Community Supports, Inc.
- Dental Excel P.a.
All providers in Bound Brook, NJ · Foot Surgery Podiatrist in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 3, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.