NPIMap

Organization Active NPI

Jack R Nizewitz & Gary J Lake PC

  • Optometrist
  • Middletown, NY
National Provider Identifier
1952528457
Registry record updated May 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JACK R NIZEWITZ & GARY J LAKE PC
Practice address
200 Midway Park Dr
Middletown, NY 10940-2642
Phone
(845) 343-6919
Fax
(845) 343-4545
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2014

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

Authorized official

Name
Jack R Nizewitz
Title
Optometrist/Owner
Phone
(845) 343-6919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

200 Midway Park Dr
Middletown, NY 10940-2642

Mailing address

200 Midway Park Drive
Middletown, NY 10940-4545
Phone (845) 343-6919

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140305000490 NY Part B Supplier - Clinic/Group Practice 7416076906 Receives reassigned benefits from 4 practitioners
Practice locations: Middletown, NY

National Provider Directory

National Provider Directory

Locations

200 Midway Park Dr
Middletown, NY 10940
Phone (845) 343-6919

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1401235200000",
    "number": "1952528457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MIDWAY PARK DRIVE",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109404545",
            "telephone_number": "845-343-6919",
            "fax_number": "845-343-4545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MIDWAY PARK DR",
            "city": "MIDDLETOWN",
            "state": "NY",
            "postal_code": "109402642",
            "telephone_number": "845-343-6919",
            "fax_number": "845-343-4545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK R NIZEWITZ & GARY J LAKE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2014-05-28",
        "status": "A",
        "authorized_official_last_name": "NIZEWITZ",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OPTOMETRIST/OWNER",
        "authorized_official_telephone_number": "845-343-6919"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middletown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.