Family Legacy Medical Care, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

FAMILY LEGACY MEDICAL CARE, PA

Practice address

115 Jefferson Ave
Elizabeth, NJ 07201-2417

Phone

(908) 351-6663

Fax

(908) 351-1760

NPI assigned

Jun 15, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Pascale Ferdinand, MDNPI 1487067856

Title

Physician

Phone

(908) 351-6663

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Pascale Ferdinand, MD

  • Family Medicine Physician
  • Elizabeth, NJ
  • NPI 1487067856
  Medicare reassignment Authorized official
• Michel-Ange Ferdinand, MD

  • Family Medicine Physician
  • Elizabeth, NJ
  • NPI 1770686289
  Medicare reassignment

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547856000000",
    "number": "1043704810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 JEFFERSON AVE",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072012417",
            "telephone_number": "908-351-6663",
            "fax_number": "908-351-1760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 JEFFERSON AVE",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "072012417",
            "telephone_number": "908-351-6663",
            "fax_number": "908-351-1760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "60 Evergreen Pl",
            "address_purpose": "LOCATION",
            "city": "East Orange",
            "state": "NJ",
            "postal_code": "070182106",
            "country_code": "US",
            "telephone_number": "973-675-0097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILY LEGACY MEDICAL CARE, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-15",
        "last_updated": "2019-01-19",
        "status": "A",
        "authorized_official_last_name": "FERDINAND",
        "authorized_official_first_name": "PASCALE",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "908-351-6663",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14126510",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "10655985",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Family & Cosmetic Dentistry of N. Broad, LLC
• Family and Children'S Service Inc
• Family and Children'S Services, Inc
• Family Dental Practice of New Jersey, LLC
• Family First Home Care & Companionship Services
• Family Medical Group, P.C.
• Family Medical Group, PC
• Liqi Fan, M.D.
• William Farrer, MD
• Emily A Fasulo

• Family Medicine Physician in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2019; 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.