Individual provider Active NPI

Tarek Adib Nakhla, MD

  • Neonatal-Perinatal Medicine Physician
  • Camden, NJ
National Provider Identifier
1205913944
Registry record updated Mar 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X
License
MA06853400 Issued in NJ
Practice address
1 Cooper PLZ
Camden, NJ 08103-1461
Phone
(856) 342-2000
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal-Perinatal Medicine Physician 2080N0001X MD052094L PA
Neonatal-Perinatal Medicine Physician 2080N0001X MA68534 NJ
Neonatal-Perinatal Medicine Physician 2080N0001X MA06853400 NJ Primary

Addresses

Primary practice location

1 Cooper PLZ
Camden, NJ 08103-1461

Mailing address

1 Federal St # 200
Camden, NJ 08103-1088
Phone (856) 356-4924

Other identifiers 1

IdentifierTypeStateIssuer
8879605MedicaidNJ

Other names 1

  • Tarek Adib Boulos Nakhla Other name

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
I20120329000740 NJ Practitioner - Pediatric Medicine 2264692110 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA06853400NJMDNeonatal-Perinatal Medicine Physician
MA68534NJMDNeonatal-Perinatal Medicine Physician
MD052094LPAMDNeonatal-Perinatal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nemours New Jersey Physician Practice, P.C. CurrentSince Jun 1, 2014 Accepting new patients
Childrens Health Care Associates of New Jersey PC CurrentSince Mar 1, 2021 Accepting new patients
Cooper Pediatric Specialists, PC CurrentSince Apr 1, 2018 Accepting new patients
Childens Health Care Associates of New Jersey PC CurrentSince Mar 1, 2021 Accepting new patients
Virtua - West Jersey Health System, Inc. Past Accepting new patients

Locations

1 Cooper Plz
Fl 7
Camden, NJ 08103
Phone (856) 342-2265

3 Cooper Plz
Rm 200
Camden, NJ 08103
Phone (609) 342-2001

1 Cooper Plz
Camden, NJ 08103
Phone (856) 342-2425

110 Marter Ave
Ste 402
Moorestown, NJ 08057
Phone (856) 234-7073

707 Alexander Rd
Princeton, NJ 08540
Phone (609) 520-1717

1012 Laurel Oak Rd
Voorhees, NJ 08043
Phone (856) 435-0086

1280 Almonesson Rd
Woodbury, NJ 08096
Phone (856) 345-1401

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1205913944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FEDERAL ST # 200",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031088",
            "telephone_number": "856-356-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COOPER PLZ",
            "city": "CAMDEN",
            "state": "NJ",
            "postal_code": "081031461",
            "telephone_number": "856-342-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAKHLA",
        "first_name": "TAREK",
        "middle_name": "ADIB",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "PA",
            "license": "MD052094L",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NJ",
            "license": "MA68534",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "NJ",
            "license": "MA06853400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8879605",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TAREK ADIB",
            "last_name": "BOULOS NAKHLA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Camden, NJ

Sources for this page

Verify at the official NPI Registry.