Innovative Medical Group NJ, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

INNOVATIVE MEDICAL GROUP NJ, LLC

Doing business as

Forward

Practice address

660 4TH St # 202
San Francisco, CA 94107-1618

Phone

(415) 349-0850

NPI assigned

Aug 10, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Nathan Favini, MD

Title

Manager

Phone

(415) 349-0850

Specialties & licenses 1

Addresses

Other names 1

• Forward Doing business as

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

{
    "created_epoch": "1660089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660089600000",
    "number": "1417685256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 4TH ST # 202",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941071618",
            "telephone_number": "415-349-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 4TH ST # 202",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941071618",
            "telephone_number": "415-349-0850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL GROUP NJ, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-10",
        "last_updated": "2022-08-10",
        "certification_date": "2022-07-26",
        "status": "A",
        "authorized_official_last_name": "FAVINI",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "415-349-0850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forward",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Van Innes
• J Juliano Innocenti, PMHNP-BC
• Innovative Dental Care
• Innovative Home Care Inc (ComForcare Home Care)
• Innovative Medical Group FL, PLLC
• Innovative Medical Group Ny, PLLC (Forward)
• Innovative Medical Practice of Massachusetts, PC
• Innovative Medical Practice of Massachusetts, PC
• Innovative Medical Practice of New York PC
• Innovative Medical Practice of New York PC

• Primary Care Clinic/Center in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.