Ennoble HC NJ III PC
Organization Active NPI Geriatric Medicine (Family Medicine) Physician · Hackensack, NJ
NPI 1043192099 · NPPES record last updated Aug 29, 2025
Key facts
- NPI
- 1043192099
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 207QG0300X
- Legal business name
- ENNOBLE HC NJ III PC
- Practice address
- 2 University PLZ Ste 204
Hackensack, NJ 07601-6211 - Phone
- (551) 295-8223
- NPI assigned
- Jul 22, 2025
- Organization subpart
- No
Authorized official
- Name
- Mark Bradshaw, MD
- Title
- Owner
- Phone
- (678) 665-2618
Practitioners 141
-
Mark Bradshaw, M.D
-
Gregorie Acceus, APN
-
Anastasia Alosi, FNP
-
Mary Kristelyn Ann Asok, MSN APRN FNP-BC
-
Shirielle Tziporah Avakian, NURSE PRACTITIONER
-
Nontika Blango, MSN, APRN, A-GNP-C
-
Marina Bloshteyn, ANP
-
Jennifer Lynn Brooks, AGNP-C
-
Breshelle Brown, FNP
-
Chayla Lynore Brown, APN
-
Lauren Carruth Mehnert, M.D.
-
Erin Chini, APN
-
Brittany Craig, APRN
-
Kathleen Cummings, APN
-
Victoria Ann D'Amico, MSN FNP-BC
-
Betty Danquah-Asare, APRN
-
Susan Dolphin, MSN, APN, FNP-C
-
Andrea P Faller, FNBC
-
Ann M Foster, APN-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NJ, OK, PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250911004607 | NJ | Part B Supplier - Clinic/Group Practice | 5294238531 |
Receives reassigned benefits from 81 practitioners Practice locations: Hackensack, NJ |
| O20250912001618 | OK | Part B Supplier - Clinic/Group Practice | 5294238531 |
Receives reassigned benefits from 31 practitioners Practice locations: Edmond, OK |
| O20251013003531 | PA | Part B Supplier - Clinic/Group Practice | 5294238531 |
Receives reassigned benefits from 38 practitioners Practice locations: Jenkintown, PA |
National Provider Directory
Locations
1000 Haddonfield Berlin Rd
Ste 205
Voorhees, NJ 08043
Phone (973) 241-1356
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | Yes |
Addresses
Primary practice location
2 University PLZ Ste 204
Hackensack, NJ 07601-6211
Mailing address
2 University PLZ Ste 204
Hackensack, NJ 07601-6211
Phone (551) 295-8223
Other practice location 1
325 Chestnut St Ste 800
Philadelphia, PA 19106-2608
Phone (973) 241-1356
Other practice location 2
101 Greenwood Ave Ste 140
Jenkintown, PA 19046-2627
Phone (973) 241-1356
Other practice location 3
1000 Haddonfield Berlin Rd Ste 205
Voorhees, NJ 08043-3520
Phone (973) 241-1356
Other practice location 4
101 W Hefner Rd
Oklahoma City, OK 73114-6631
Phone (405) 896-8058
Other practice location 5
3209 S Broadway Ste 229
Edmond, OK 73013-4064
Phone (551) 295-8223
Other providers in Hackensack, NJ
- Ennoble HC Ky II PLLC
- Ennoble HC Ky III PLLC
- Ennoble HC Ky PLLC
- Ennoble HC Mso Holdco Inc
- Ennoble HC NJ II PC
- Ennoble HC NJ PC
- Ennoble HC TX II PA
- Ennoble HC TX III PA
- Ennoble HC TX PA
- Rachel Anne Tomas Enriquez
All providers in Hackensack, NJ · Geriatric Medicine (Family Medicine) 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 29, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.