Raleke O Adibe, DO
Individual provider Active NPI Family Medicine Physician · Somerdale, NJ
NPI 1477081156 · NPPES record last updated Sep 23, 2022
Key facts
- NPI
- 1477081156
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- P18-00908 (NJ)
- Practice address
- 1 S White Horse Pike
Somerdale, NJ 08083-1737 - Phone
- (856) 545-9620
- NPI assigned
- May 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- St Josephs Medical Group PC
Passaic Hospitalist Services, LLC
Practice addresses (Care Compare)
11 Getty Ave
2ND Floor
Paterson, NJ 07503-1804
Phone (973) 754-4399
703 Main St
Paterson, NJ 07503-2621
Phone (973) 754-2000
Hospital & facility affiliations
- St Joseph'S University Medical Center Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211214001619 | NJ | Practitioner - Family Practice | 4688064249 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P18-00908 | NJ | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Passaic Hospitalist Services, LLC | Current |
Accepting new patients | |
| St Josephs Medical Group PC | Current |
Accepting new patients |
Locations
703 Main St
Paterson, NJ 07503
Phone (973) 754-2240
703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331
11 Getty Ave
2ND FL
Paterson, NJ 07503
Phone (973) 754-2526
11 Getty Ave
2ND FL
Paterson, NJ 07503
220 Hamburg Tpke
Ste 203
Wayne, NJ 07470
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | P18-00908 | NJ | Yes |
Addresses
Primary practice location
1 S White Horse Pike
Somerdale, NJ 08083-1737
Mailing address
1 S White Horse Pike
Somerdale, NJ 08083-1737
Phone (856) 545-9620
Other providers in Somerdale, NJ
- Mitra Abdollahi
- Accessibility Community Services
- Accessibility Transportation LLC
- Advocare, LLC
- Alan D. Budman
- Am Producta USA LLC
- Assuring Support Services
- Geraldine Atkins
All providers in Somerdale, NJ · 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 Sep 23, 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.