NPIMap

Organization Active NPI

Ennoble HC NJ PC

  • Geriatric Medicine (Family Medicine) Physician
  • Hackensack, NJ
National Provider Identifier
1306500764
Registry record updated Nov 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
ENNOBLE HC NJ PC
Practice address
2 University PLZ
Hackensack, NJ 07601-6202
Phone
(973) 435-9463
NPI assigned
Oct 22, 2021
Last updated
Nov 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2022

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

Authorized official

Name
Kushabhadra Das
Title
Ceo
Phone
(862) 812-9010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

2 University PLZ
Hackensack, NJ 07601-6202

Mailing address

2 University Plaza Drive
Suite 204
Hackensack, NJ 07601
Phone (973) 241-1356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20211027000609 PA Part B Supplier - Clinic/Group Practice 0345638185 Receives reassigned benefits from 49 practitioners
Practice locations: Philadelphia, PA
O20211028000825 NJ Part B Supplier - Clinic/Group Practice 0345638185 Receives reassigned benefits from 107 practitioners
Practice locations: Hackensack, NJ
O20240910002533 OK Part B Supplier - Clinic/Group Practice 0345638185 Receives reassigned benefits from 45 practitioners
Practice locations: Edmond, OK

National Provider Directory

National Provider Directory

Locations

100 Kingston Rd
Sulphur, LA 70663
Phone (337) 625-5810

1000 Haddonfield Berlin Rd
Ste 205
Voorhees, NJ 08043
Phone 9732411356 ext. 11356

Practitioners & affiliated clinicians

Practitioners 195

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 195

NPI Registry JSON

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1306500764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 UNIVERSITY PLAZA DRIVE",
            "address_2": "SUITE 204",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "07601",
            "telephone_number": "973-241-1356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 UNIVERSITY PLZ",
            "city": "HACKENSACK",
            "state": "NJ",
            "postal_code": "076016202",
            "telephone_number": "973-435-9463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENNOBLE HC NJ PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-22",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "DAS",
        "authorized_official_first_name": "KUSHABHADRA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "862-812-9010"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hackensack, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; 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.