A&S General Physician LLC
Organization Active NPI Internal Medicine Physician · Clifton, NJ
NPI 1295086908 · NPPES record last updated Jan 12, 2016
Key facts
- NPI
- 1295086908
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- A&S GENERAL PHYSICIAN LLC
- Practice address
- 1137 Main Ave
Clifton, NJ 07011-2386 - Phone
- (973) 773-0303
- Fax
- (973) 773-0004
- NPI assigned
- Sep 21, 2012
- Organization subpart
- No
Authorized official
- Name
- Angel R De la Cruz, MD
- Title
- Owner
- Phone
- (973) 773-0303
Practitioners 2
-
Liss Speziale, NP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D2045520 | A&S General Physician LLC | Certificate of waiver | Aug 14, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120927000519 | NJ | Part B Supplier - Clinic/Group Practice | 5092964544 |
Receives reassigned benefits from 2 practitioners Practice locations: Clifton, NJ |
National Provider Directory
Locations
1137 Main Ave
Clifton, NJ 07011
Phone (973) 405-3900
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CFHECA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1137 Main Ave
Clifton, NJ 07011-2386
Mailing address
1137 Main Ave
Clifton, NJ 07011-2386
Phone (973) 773-0303
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0300161 | Medicaid | NJ |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 12, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.