Individual provider Active NPI

Edyta Kinga Wisniewska, NP

  • Acute Care Nurse Practitioner
  • New York, NY
National Provider Identifier
1780114157
Registry record updated Oct 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
715683-1 Issued in NY
Practice address
173 Fort Washington Ave
New York, NY 10032-3739
Phone
(212) 305-2500
NPI assigned
Jun 18, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 3, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 715683-1 NY
Critical Care Medicine Registered Nurse 163WC0200X 26NR16881300 NJ
Acute Care Nurse Practitioner 363LA2100X 715683-1 NY Primary

Addresses

Primary practice location

173 Fort Washington Ave
New York, NY 10032-3739

Mailing address

32 Spring St Apt 120
Wallington, NJ 07057-2030
Phone (551) 795-3024

Other practice location 1

30 Prospect Ave
Hackensack, NJ 07601-1915
Phone (551) 996-2000 ext. 2576

Other identifiers 1

IdentifierTypeStateIssuer
W46691947256904OtherNJDRIVER'S LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20190215001754 NY Practitioner - Nurse Practitioner 8426396441 Reassigns benefits to 1 organization
I20230223000144 TX Practitioner - Nurse Practitioner 8426396441 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Columbia University College of Physicians and Surgeons, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Houston Methodist Specialty PhysiciansGroup PAC ID 5193239796, 1,498 clinicians
TMH Physician Associates PLLCGroup PAC ID 4486711744, 1,881 clinicians

Practice addresses (Care Compare)

6445 Main St
Suite 2500
Houston, TX 77030-1502
Phone (713) 441-3150

6565 Fannin St
Suite B452
Houston, TX 77030-2703
Phone (713) 441-3620

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NR16881300NJMDCritical Care Medicine Registered Nurse
715683-1NYMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
TMH Physician Associates PLLC CurrentSince Jan 23, 2023 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Dec 25, 2018 Accepting new patients
TMH Physician Associates PLLC CurrentSince Jan 23, 2023 Accepting new patients
Trustees of Columbia University in the City of New York CurrentSince Dec 25, 2018 Accepting new patients

Locations

622 W 168th St
New York, NY 10032
Phone (212) 305-4931

161 Fort Washington Ave
New York, NY 10032
Phone (212) 305-8559

622 W 168th St
Ph 5505
New York, NY 10032
Phone (212) 305-6494

173 Fort Washington Ave
New York, NY 10032
Phone (212) 305-4600

7575 San Felipe St
Ste 155
Houston, TX 77063
Phone (713) 266-9955

6565 Fannin St
Ste B452
Houston, TX 77030
Phone (713) 441-3620

16605 Southwest Fwy
Ste 400
Sugar Land, TX 77479
Phone (281) 275-0800

Interoperability endpoints

  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: ewisniewska434965@directhoustonmethodist.org
  • FHIR API: https://epicproxy-pub.et1089.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570060800000",
    "number": "1780114157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 SPRING ST APT 120",
            "city": "WALLINGTON",
            "state": "NJ",
            "postal_code": "070572030",
            "telephone_number": "551-795-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 FORT WASHINGTON AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100323739",
            "telephone_number": "212-305-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "30 Prospect Ave",
            "address_purpose": "LOCATION",
            "city": "Hackensack",
            "state": "NJ",
            "postal_code": "076011915",
            "country_code": "US",
            "telephone_number": "551-996-2000 x2576",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISNIEWSKA",
        "first_name": "EDYTA",
        "middle_name": "KINGA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-18",
        "last_updated": "2019-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NY",
            "license": "715683-1",
            "primary": false
        },
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NJ",
            "license": "26NR16881300",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NY",
            "license": "715683-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER'S LICENSE",
            "identifier": "W46691947256904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.