Lisa Wydra

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

26NR09130100 Issued in NJ

Practice address

3391 Highway 35
Hazlet, NJ 07730-1521

Phone

(732) 888-8299

NPI assigned

Feb 15, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ocean Allergy Partners, LLCGroup PAC ID 0345636510, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Ocean Allergy Partners, LLC

  • Allergy & Immunology Physician
  • Brick, NJ
  • NPI 1821753849
  Medicare reassignment Care Compare group NPD
• Bruce a. Decotiis MD PA

  • Allergy & Immunology Physician
  • Brick, NJ
  • NPI 1861579559
  NPD (past)
• Simone Family Medicine, LLC

  • Primary Care Clinic/Center
  • Matawan, NJ
  • NPI 1912109687
  NPD (past)

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

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548288000000",
    "number": "1780916916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3391 HIGHWAY 35",
            "city": "HAZLET",
            "state": "NJ",
            "postal_code": "077301521",
            "telephone_number": "732-888-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3391 HIGHWAY 35",
            "city": "HAZLET",
            "state": "NJ",
            "postal_code": "077301521",
            "telephone_number": "732-888-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYDRA",
        "first_name": "LISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-15",
        "last_updated": "2019-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ00285700",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NR09130100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Wieder
• Dana Wilkins, LPC
• Joan Wojtowicz, OT
• Caitlin Wood-Yesline, OD
• Herng Wu
• Lin Xu, M.D.
• Y Lorraine Durrett LLC
• YMCA of Greater Monmouth County
• YMCA of Greater Monmouth County
• YMCA of Greater Monmouth County

• Family Nurse Practitioner in Hazlet, NJ
• Providers in Hazlet, NJ by specialty
• Family Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.