Physician Compare National (NPI:1699861658)

HEALTHCARE PROVIDER: NICHOLAS ANTHONY VIDETTI MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1699861658
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6204889603
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050225000201
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	VIDETTI
	Individual professional last name
Provider First Name	NICHOLAS
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	PSYCHIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	127 UNION ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 109
	Group Practice or individual's line 2 address
City	RIDGEWOOD
	Group Practice or individual's city
State	NJ
	Group Practice or individual's state
Zip Code	074504436
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2014441255
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	M