Park Ave Medical Centre LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA08760600 Issued in NJ

Legal business name

PARK AVE MEDICAL CENTRE LLC

Practice address

535 Getty Ave
Suite 3
Clifton, NJ 07011-2105

Phone

(862) 239-4808

NPI assigned

Sep 22, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Rafath K Humera, MDNPI 1376871202

Title

Sole Propreiter

Phone

(862) 239-4808

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9939/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Rafath Khatoon Humera, M.D

  • Internal Medicine Physician
  • Clifton, NJ
  • NPI 1376871202
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316649600000",
    "number": "1447533773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1367 RATZER RD",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702429",
            "telephone_number": "862-239-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 GETTY AVE",
            "address_2": "SUITE 3",
            "city": "CLIFTON",
            "state": "NJ",
            "postal_code": "070112105",
            "telephone_number": "862-239-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK AVE MEDICAL CENTRE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-22",
        "last_updated": "2011-09-22",
        "status": "A",
        "authorized_official_last_name": "HUMERA",
        "authorized_official_first_name": "RAFATH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SOLE PROPREITER",
        "authorized_official_telephone_number": "862-239-4808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA08760600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sanjiv R Parikh, M.D.
• Joon Hyung Park, D.D.S.
• Seoun H Park, ANP
• Brianna Parsons
• Parthiv V Raval,MD LLC
• Partnerships for People, Inc.

• Internal Medicine Physician in Clifton, NJ
• Providers in Clifton, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2011; 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.