NPIMap

Organization Active NPI

Ennoble HC NJ III PC

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
National Provider Identifier
1043192099
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 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
Last updated
Aug 29, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Authorized official

Name
Mark Bradshaw, MDNPI 1316107428
Title
Owner
Phone
(678) 665-2618

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X Primary

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

101 Greenwood Ave Ste 140
Jenkintown, PA 19046-2627
Phone (973) 241-1356

Other practice location 2

325 Chestnut St Ste 800
Philadelphia, PA 19106-2608
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

3209 S Broadway Ste 229
Edmond, OK 73013-4064
Phone (551) 295-8223

Other practice location 5

101 W Hefner Rd
Oklahoma City, OK 73114-6631
Phone (405) 896-8058

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ, OK, PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 141

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 141

NPI Registry JSON

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

{
    "created_epoch": "1753142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756425600000",
    "number": "1043192099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 UNIVERSITY PLZ STE 204",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016211",
            "telephone_number": "551-295-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 UNIVERSITY PLZ STE 204",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016211",
            "telephone_number": "551-295-8223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "101 Greenwood Ave Ste 140",
            "address_purpose": "LOCATION",
            "city": "Jenkintown",
            "state": "PA",
            "postal_code": "190462627",
            "country_code": "US",
            "telephone_number": "973-241-1356",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 Chestnut St Ste 800",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191062608",
            "country_code": "US",
            "telephone_number": "973-241-1356",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Haddonfield Berlin Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Voorhees",
            "state": "NJ",
            "postal_code": "080433520",
            "country_code": "US",
            "telephone_number": "973-241-1356",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3209 S Broadway Ste 229",
            "address_purpose": "LOCATION",
            "city": "Edmond",
            "state": "OK",
            "postal_code": "730134064",
            "country_code": "US",
            "telephone_number": "551-295-8223",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "101 W Hefner Rd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731146631",
            "country_code": "US",
            "telephone_number": "405-896-8058",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ENNOBLE HC NJ III PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-22",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A",
        "authorized_official_last_name": "BRADSHAW",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-665-2618",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2025; 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.