Tochukwu G. Mbolu, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA11948900 Issued in NJ

Practice address

1 Bay Ave
Montclair, NJ 07042-4837

Phone

(862) 333-4700

Fax

(973) 893-5439

NPI assigned

Apr 6, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Heart and Vascular Associates of Northern Jersey, P.a.Group PAC ID 4183610520, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Joseph'S University Medical Center Inc Hospital, Paterson, NJ, CCN 310019

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Heart & Vascular Associates of Northern Jersey, P.a.

  • Specialist
  • Fair Lawn, NJ
  • NPI 1699889980
  Medicare reassignment Care Compare group
• Atlanticare Physician Group PA

  • Clinic/Center
  • Egg Harbor Township, NJ
  • NPI 1093829608

  Hospitalist

  Medicare reassignment NPD
• Signify Health Medical Associates of New Jersey, LLC

  • General Practice Physician
  • Princeton, NJ
  • NPI 1174187728
  Medicare reassignment NPD
• Atlanticare Physician Group

  • Clinical Social Worker
  • Egg Harbor Township, NJ
  • NPI 1881618494
  NPD
• Atlanticare Physician Group, PA

  • Urgent Care Clinic/Center
  • Galloway, NJ
  • NPI 1003820622
  NPD
• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Josephs University Medical Center Inc.

  • General Acute Care Hospital
  • Paterson, NJ
  • NPI 1669462420
  Care Compare affiliation

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1144859620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BAY AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424837",
            "telephone_number": "862-333-4700",
            "fax_number": "973-893-5439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BAY AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070424837",
            "telephone_number": "862-333-4700",
            "fax_number": "973-893-5439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MBOLU",
        "first_name": "TOCHUKWU",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NJ",
            "license": "25MA11948900",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA11948900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosaria Matos, LCSW
• Joyce L Mauer, MSW, LCSW
• Lauren Maynard
• Valeisha Mayton
• Ekaterina Maza, LSW
• Samantha McAleer
• Michael Patrick McCann, LCSW
• Kevin J McCoach, MD FACC
• Garrett McConville
• Samantha Marie McCormack, APN

• Internal Medicine Physician in Montclair, NJ
• Providers in Montclair, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.