Individual provider Active NPI

Cheryl Buensuceso Panem, M.D.

  • Pediatrics Physician
  • West New York, NJ
National Provider Identifier
1215972476
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
25MA07821400 Issued in NJ
Practice address
5301 Broadway
West New York, NJ 07093-2622
Phone
(201) 866-9320
Fax
(201) 867-9183
NPI assigned
Jun 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 25MA07821400 NJ Primary

Addresses

Primary practice location

5301 Broadway
West New York, NJ 07093-2622

Mailing address

98 Romaine Ave
Jersey City, NJ 07306-5302
Phone (201) 963-6706

Other identifiers 1

IdentifierTypeStateIssuer
0066478MedicaidNJ

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
I20110906000231 NJ Practitioner - Pediatric Medicine 8022031350 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Joseph's Healthcare, Inc. CurrentSince May 20, 2019 Accepting new patients
St Josephs Medical Group PC CurrentSince Nov 1, 2021 Accepting new patients
St Josephs University Medical Center Inc. Past Accepting new patients

Locations

703 Main St
Bldg 400
Paterson, NJ 07503
Phone (973) 754-2054

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

11 Getty Ave
Paterson, NJ 07503
Phone (973) 754-4200

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

703 Main St
Rm XG2126
Paterson, NJ 07503
Phone (973) 754-2240

11 Getty Ave
Paterson, NJ 07503

220 Hamburg Tpke
Ste 203
Wayne, NJ 07470

Organizations & group practices 3

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": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215972476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "98 ROMAINE AVE",
            "city": "JERSEY CITY",
            "state": "NJ",
            "postal_code": "073065302",
            "telephone_number": "201-963-6706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 BROADWAY",
            "city": "WEST NEW YORK",
            "state": "NJ",
            "postal_code": "070932622",
            "telephone_number": "201-866-9320",
            "fax_number": "201-867-9183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANEM",
        "first_name": "CHERYL",
        "middle_name": "BUENSUCESO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NJ",
            "license": "25MA07821400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0066478",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West New York, NJ

Sources for this page

Verify at the official NPI Registry.