Individual provider Active NPI

Jacquelin Holubka, M.D.

  • Internal Medicine Physician
  • Livingston, NJ
National Provider Identifier
1174577373
Registry record updated Sep 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06300800 Issued in NJ
Practice address
94 Old Short Hills Rd
Livingston, NJ 07039-5672
Phone
(973) 993-9536
NPI assigned
May 20, 2006
Last updated
Sep 17, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA06300800 NJ Primary

Addresses

Primary practice location

94 Old Short Hills Rd
Livingston, NJ 07039-5672

Mailing address

PO Box 303
Mount Freedom, NJ 07970-0303
Phone (973) 993-9536

Other identifiers 1

IdentifierTypeStateIssuer
6887503MedicaidNJ

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20040420000973 NJ Practitioner - Internal Medicine 9638070147 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Human Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Howard Holtz LLCGroup PAC ID 5496061707, 2 clinicians

Practice addresses (Care Compare)

1500 Pleasant Valley Way
Suite 205
West Orange, NJ 07052-2956
Phone (973) 669-9797

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
25MA06300800NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mayor Group, LLC Internal Medicine CurrentSince Jul 8, 2011 Accepting new patients
Howard Holtz, LLC Internal Medicine CurrentSince Aug 1, 2015 Accepting new patients
Ipc Hospitalist Physicians of New Jersey PC Internal Medicine Past Accepting new patients
Internal Medicine Faculty Practice Associates at St Barnabas Med Ctr Internal Medicine Past Accepting new patients
Ipc Hospitalist Physicians of New Jersey PC Internal Medicine Past Accepting new patients

Locations

311 S Livingston Ave
Livingston, NJ 07039
Phone (973) 937-7831

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

1199 Pleasant Valley Way
West Orange, NJ 07052
Phone (973) 414-4755

1199 Pleasant Valley Way
#F
West Orange, NJ 07052

1500 Pleasant Valley Way
Ste 205
West Orange, NJ 07052
Phone (973) 669-9797

5 Brook End Dr
West Orange, NJ 07052
Phone (973) 324-3000

Organizations & group practices 6

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

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1221609600000",
    "number": "1174577373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 303",
            "city": "MOUNT FREEDOM",
            "state": "NJ",
            "postal_code": "079700303",
            "telephone_number": "973-993-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 OLD SHORT HILLS RD",
            "city": "LIVINGSTON",
            "state": "NJ",
            "postal_code": "070395672",
            "telephone_number": "973-993-9536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLUBKA",
        "first_name": "JACQUELIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-20",
        "last_updated": "2008-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06300800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6887503",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Livingston, NJ

Sources for this page

Verify at the official NPI Registry.