NPIMap

Organization Active NPI

North Haledon Medical, PC

  • Specialist
  • Wayne, NJ
National Provider Identifier
1477624088
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
25MB06978600 Issued in NJ
Legal business name
NORTH HALEDON MEDICAL, PC
Practice address
510 Hamburg Tpke
Wayne Commons, Suite 101
Wayne, NJ 07470-2025
Phone
(973) 942-6005
Fax
(973) 942-6009
NPI assigned
Nov 13, 2006
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Anthony BarravecchioNPI 1114996477
Title
Delegated Official
Phone
(973) 942-6005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 25MB06978600 NJ Primary

Addresses

Primary practice location

510 Hamburg Tpke
Wayne Commons, Suite 101
Wayne, NJ 07470-2025

Mailing address

510 Hamburg Tpke
Wayne Commons, Suite 101
Wayne, NJ 07470-2025
Phone (973) 942-6005

Other identifiers 4

IdentifierTypeStateIssuer
2016615002OtherNJAMERIHEALTH GROUP #
7305262OtherNJAETNA GROUP #
8644101MedicaidNJ
DC3972OtherNJRAILROAD MDCR GROUP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050121000032 NJ Part B Supplier - Clinic/Group Practice 0345299947 Receives reassigned benefits from 39 practitioners
Practice locations: Wayne, NJ

National Provider Directory

National Provider Directory

Locations

535 High Mountain Rd
Ste 202
North Haledon, NJ 07508
Phone (973) 427-6975

510 Hamburg Tpke
Ste 101
Wayne, NJ 07470
Phone (973) 427-6975

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1477624088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE",
            "address_2": "WAYNE COMMONS, SUITE 101",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702025",
            "telephone_number": "973-942-6005",
            "fax_number": "973-942-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 HAMBURG TPKE",
            "address_2": "WAYNE COMMONS, SUITE 101",
            "city": "WAYNE",
            "state": "NJ",
            "postal_code": "074702025",
            "telephone_number": "973-942-6005",
            "fax_number": "973-942-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH HALEDON MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "BARRAVECCHIO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "973-942-6005"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MB06978600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH GROUP #",
            "identifier": "2016615002",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP #",
            "identifier": "7305262",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8644101",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MDCR GROUP #",
            "identifier": "DC3972",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; 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.