Ketaki Vaidhyanathan, M.D.
Individual provider Active NPI Psychiatry Physician · Montclair, NJ
NPI 1992904445 · NPPES record last updated Aug 3, 2010
Key facts
- NPI
- 1992904445
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatry Physician 2084P0800X
- License
- 25MA08170600 (NJ)
- Practice address
- 1 Bay Ave
Montclair, NJ 07042-4837 - Phone
- (973) 429-6260
- NPI assigned
- Jul 15, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Psychiatry
- Education
- Rutgers New Jersey Medical School, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Josephs Healthcare Inc
Practice addresses (Care Compare)
641 Main St
Paterson, NJ 07503-3028
Phone (973) 754-4750
Hospital & facility affiliations
- St Joseph'S University Medical Center Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090519000058 | NJ | Practitioner - Psychiatry | 0446309645 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montclair Hospital LLC | Psychiatry | Current |
Accepting new patients |
| St. Joseph'S Healthcare, Inc. | Current |
Accepting new patients | |
| Montclair Hospital LLC | Current |
Accepting new patients | |
| St Josephs Medical Group PC | Current |
Accepting new patients | |
| St Josephs University Medical Center Inc. | Past |
Accepting new patients |
Locations
1 Bay Ave
Montclair, NJ 07042
Phone (973) 429-6100
30 W Century Rd
Paramus, NJ 07652
Phone (201) 261-2000
703 Main St
Rm XG2126
Paterson, NJ 07503
Phone (973) 754-2240
703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331
641 Main St
Paterson, NJ 07503
Phone (973) 754-2575
703 Main St
Paterson, NJ 07503
Phone (973) 754-2240
Interoperability endpoints
- kvaidhyanathan@sjhbh.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 25MA08170600 | NJ | Yes |
Addresses
Primary practice location
1 Bay Ave
Montclair, NJ 07042-4837
Mailing address
137 Romaine Ave
Maywood, NJ 07607-1948
Phone (201) 845-5289
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0232084 | Medicaid | NJ |
Other providers in Montclair, NJ
- United Surgical Assists LLC
- United Woundcare Institute PC
- Universal Counseling LLC
- Upper Montclair Eye Care & Wear LLC
- Frances Adele Vadas
- John-Eric Vallarta
- Ann Frances Vallone
- Franz Emmanuelle Valmores
- Van Dyk Healthcare, Inc.
- Peggy Van Raalte
All providers in Montclair, NJ · Psychiatry Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.