Organization Active NPI

Pande V. Josifoski, M.D., L.L.C.

  • Primary Care Clinic/Center
  • Glen Ridge, NJ
National Provider Identifier
1053631846
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
25MA02629900 Issued in NJ
Legal business name
PANDE V. JOSIFOSKI, M.D., L.L.C.
Practice address
123 Highland Ave
Suite 203
Glen Ridge, NJ 07028-1527
Phone
(973) 748-0678
Fax
(973) 748-2808
NPI assigned
Jun 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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

Authorized official

Name
Mrs. Maria Palacios
Title
Medical Assistant
Phone
(973) 748-0678

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 25MA02629900 NJ Primary

Addresses

Primary practice location

123 Highland Ave
Suite 203
Glen Ridge, NJ 07028-1527

Mailing address

123 Highland Ave
Suite 203
Glen Ridge, NJ 07028-1527
Phone (973) 748-0678

Other identifiers 1

IdentifierTypeStateIssuer
1D1696904MedicaidNJ

National Provider Directory

National Provider Directory

Locations

123 Highland Ave
Ste 203
Glen Ridge, NJ 07028
Phone (973) 746-7474

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1275523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275523200000",
    "number": "1053631846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 HIGHLAND AVE",
            "address_2": "SUITE 203",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070281527",
            "telephone_number": "973-748-0678",
            "fax_number": "973-748-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 HIGHLAND AVE",
            "address_2": "SUITE 203",
            "city": "GLEN RIDGE",
            "state": "NJ",
            "postal_code": "070281527",
            "telephone_number": "973-748-0678",
            "fax_number": "973-748-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANDE V. JOSIFOSKI, M.D., L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-03",
        "last_updated": "2010-06-03",
        "status": "A",
        "authorized_official_last_name": "PALACIOS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "MEDICAL ASSISTANT",
        "authorized_official_telephone_number": "973-748-0678",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "25MA02629900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1D1696904",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Ridge, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.