Individual provider Active NPI

Marina Ayzenberg Gutwein, MD

  • Diagnostic Radiology Physician
  • Englewood, NJ
National Provider Identifier
1831170414
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
25MA08059300 Issued in NJ
Practice address
350 Engle St
Englewood, NJ 07631-1808
Phone
(201) 894-3480
NPI assigned
Nov 9, 2005
Sex
Female
Sole proprietor
No

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 043264 CT
Diagnostic Radiology Physician 2085R0202X 25MA08059300 NJ Primary
Diagnostic Radiology Physician 2085R0202X 235595 NY

Addresses

Primary practice location

350 Engle St
Englewood, NJ 07631-1808

Mailing address

725 Downing St
Teaneck, NJ 07666-2220
Phone (201) 357-4409

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
I20070604000708 NJ Practitioner - Diagnostic Radiology 7416989876 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Albert Einstein College of Medicine of Yeshiva University, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Englewood Radiologic Group P aGroup PAC ID 6901852300, 131 clinicians

Practice addresses (Care Compare)

350 Engle St
Englewood, NJ 07631-1808
Phone (201) 894-3480

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
235595NYMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Englewood Radiologic Group P a Diagnostic Radiology CurrentSince Jul 17, 2006 Accepting new patients

Locations

452 Old Hook Rd
Ste 301
Emerson, NJ 07630

350 Engle St
Englewood, NJ 07631
Phone (201) 871-6073

350 Engle St
Rm 145402
Englewood, NJ 07631

Organizations & group practices 1

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 1

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": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831170414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 DOWNING ST",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076662220",
            "telephone_number": "201-357-4409",
            "fax_number": "201-357-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076311808",
            "telephone_number": "201-894-3480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUTWEIN",
        "first_name": "MARINA",
        "middle_name": "AYZENBERG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CT",
            "license": "043264",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NJ",
            "license": "25MA08059300",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NY",
            "license": "235595",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.