Riverside Health Care LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

25MA09772600 Issued in NJ

Legal business name

RIVERSIDE HEALTH CARE LLC

Practice address

115 Broad Ave
Palisades Park, NJ 07650-1441

Phone

(201) 592-5959

Fax

(201) 592-5955

NPI assigned

Oct 24, 2016

Organization subpart

No

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

Authorized official

Name

Hangjun Jang, MD, PHDNPI 1568607919

Title

President

Phone

(201) 592-5959

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Riverside Health Care LLC

  • Internal Medicine Physician
  • Palisades Park, NJ
  • NPI 1497108559

  O20171031001049

  Same enrollment

Tax ID family

Ezra Medical Care PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ezra Medical Care PC

  • Internal Medicine Physician
  • Flushing, NY
  • NPI 1336554815
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hangjun Jang, M.D., PH.D.

  • Internal Medicine Physician
  • Flushing, NY
  • NPI 1568607919
  NPD Authorized official

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1295286375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 BROAD AVE",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501441",
            "telephone_number": "201-592-5959",
            "fax_number": "877-801-7479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BROAD AVE",
            "city": "PALISADES PARK",
            "state": "NJ",
            "postal_code": "076501441",
            "telephone_number": "201-592-5959",
            "fax_number": "201-592-5955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "JANG",
        "authorized_official_first_name": "HANGJUN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-592-5959",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NJ",
            "license": "25MA09772600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Palisades Park, NJ
• Providers in Palisades Park, NJ by specialty
• Primary Care Clinic/Center in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.