Jennifer Lyn Vidal, DO is a medicare enrolled "Pediatrics" physician in Harrison, New Jersey. Her current practice location is
332 Harrison Ave, Harrison, New Jersey. You can reach out to her office (for appointments etc.) via phone at
(973) 484-4584.
Jennifer Lyn Vidal is licensed to practice in New Jersey (license number 25MB08925500) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1649565201.
Physician's Profile
| Full Name | Jennifer Lyn Vidal |
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| Gender | Female |
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| Speciality | Pediatrics |
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| Location | 332 Harrison Ave, Harrison, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1649565201
- Provider Enumeration Date: 06/12/2011
- Last Update Date: 06/16/2011
Medicare PECOS Information:
- PECOS PAC ID: 8224397955
- Enrollment ID: I20180125001508
Medical Identifiers
Medical identifiers for Jennifer Lyn Vidal such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1649565201 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 208000000X | Pediatrics | 25MB08925500 (New Jersey) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jennifer Lyn Vidal allows following entities to bill medicare on her behalf.
| Entity Name | Elmer S David Md Pllc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1720324429
PECOS PAC ID: 8426271255
Enrollment ID: O20140523002213 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jennifer Lyn Vidal is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jennifer Lyn Vidal, DO
130 N 16th St,
Bloomfield, NJ 07003-5828
Ph: (973) 429-9112 | Jennifer Lyn Vidal, DO
332 Harrison Ave,
Harrison, NJ 07029-1775
Ph: (973) 484-4584 |
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