Individual provider Active NPI

Michael Adam Kindzierski, D.O.

  • Family Medicine Physician
  • Carteret, NJ
National Provider Identifier
1770656597
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
BK 4607416 Issued in NJ
Practice address
76 Carteret Ave
Carteret, NJ 07008-2517
Phone
(732) 541-9060
Fax
(732) 541-9220
NPI assigned
Nov 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X BK 4607416 NJ Primary

Addresses

Primary practice location

76 Carteret Ave
Carteret, NJ 07008-2517

Mailing address

76 Carteret Ave
Carteret, NJ 07008-2517
Phone (732) 541-9060

Other identifiers 1

IdentifierTypeStateIssuer
7206402MedicaidNJ

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
I20120119000225 NJ Practitioner - Family Practice 1951578749 Practice locations: Carteret, NJ

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Philadelphia College of Osteopathic Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

76 Carteret Ave
Carteret, NJ 07008-2517
Phone (732) 541-9060

Hospital & facility affiliations

National Provider Directory

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770656597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "76 CARTERET AVE",
            "city": "CARTERET",
            "state": "NJ",
            "postal_code": "070082517",
            "telephone_number": "732-541-9060",
            "fax_number": "732-541-9220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 CARTERET AVE",
            "city": "CARTERET",
            "state": "NJ",
            "postal_code": "070082517",
            "telephone_number": "732-541-9060",
            "fax_number": "732-541-9220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINDZIERSKI",
        "first_name": "MICHAEL",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "BK 4607416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7206402",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carteret, NJ

Sources for this page

Verify at the official NPI Registry.