Mobile Medicare

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

MB27483 Issued in NJ

Legal business name

MOBILE MEDICARE

Practice address

67 Walnut Ave
Clark, NJ 07066-1640

Phone

(732) 388-7300

Fax

(732) 388-1330

NPI assigned

Aug 30, 2006

Last updated

Aug 6, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Miss Colleen Elizabeth Tiedemann

Title

Office Manager

Phone

(732) 388-7300

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186358400000",
    "number": "1457460594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 WALNUT AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661640",
            "telephone_number": "732-388-7300",
            "fax_number": "732-388-1330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 WALNUT AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661640",
            "telephone_number": "732-388-7300",
            "fax_number": "732-388-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE MEDICARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-08-06",
        "status": "A",
        "authorized_official_last_name": "TIEDEMANN",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "732-388-7300",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "MB27483",
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "MB53933",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "MB71509",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Merrick, LPC
• MH at Clark LLC
• Ian Michael Michelin, LMSW
• Sabina Migdal
• Katelyn Miranda
• Pamela Molyneaux
• Kimberly Patrice Moore-Jones, LCSW, ACSW
• Rania Muhieddine, DO
• Multi Care Urgent Care LLC
• Multi-Care Industrial Medicine LCC

• Geriatric Medicine (Family Medicine) Physician in Clark, NJ
• Providers in Clark, NJ by specialty
• Geriatric Medicine (Family Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2007; 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.