Ennoble HC NJ PC
Organization Active NPI Geriatric Medicine (Family Medicine) Physician · Hackensack, NJ
NPI 1306500764 · NPPES record last updated Nov 8, 2022
Key facts
- NPI
- 1306500764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Geriatric Medicine (Family Medicine) Physician 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
- Organization subpart
- No
Authorized official
- Name
- Kushabhadra Das
- Title
- Ceo
- Phone
- (862) 812-9010
Practitioners 195
-
Gregorie Acceus, APN
-
Anastasia Alosi, FNP
-
Mary Kristelyn Ann Asok, MSN APRN FNP-BC
-
Nontika Blango, MSN, APRN, A-GNP-C
-
Marina Bloshteyn, ANP
-
Tonya S. Brissett, NURSE PRACTITIONER
-
Jennifer Lynn Brooks, AGNP-C
-
Breshelle Brown, FNP
-
Chayla Lynore Brown, APN
-
Lauren Carruth Mehnert, M.D.
-
Judith Anne Connell, ANP-C
-
Kathleen Cummings, APN
-
Victoria Ann D'Amico, MSN FNP-BC
-
Betty Danquah-Asare, APRN
-
Susan Dolphin, MSN, APN, FNP-C
-
Andrea P Faller, FNBC
-
Ann M Foster, APN-C
-
Robin Marie Glanton, APN
-
Nelson P. Gramatica, APN-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in PA, NJ, OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
100 Kingston Rd
Sulphur, LA 70663
Phone (318) 446-1667
101 Greenwood Ave
Ste 140
Jenkintown, PA 19046
Phone (973) 241-1356
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | Yes |
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
Other providers in Hackensack, NJ
- Ennoble HC Ky III PLLC
- Ennoble HC Ky PLLC
- Ennoble HC Mso Holdco Inc
- Ennoble HC NJ II PC
- Ennoble HC NJ III PC
- Ennoble HC TX II PA
- Ennoble HC TX III PA
- Ennoble HC TX PA
- Rachel Anne Tomas Enriquez
- Moshe Ephrat
All providers in Hackensack, NJ · Geriatric Medicine (Family Medicine) Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.