NPIMap

Organization Active NPI

Impact Health New Jersey PC

  • Nurse Practitioner
  • Roselle, NJ
National Provider Identifier
1487399689
Registry record updated Mar 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
IMPACT HEALTH NEW JERSEY PC
Practice address
580 Raritan Rd
Roselle, NJ 07203-2446
Phone
(866) 842-3559
Fax
(718) 337-8658
NPI assigned
May 2, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2026

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

Authorized official

Name
Jared Tollen
Title
Authorized Official
Phone
(203) 939-2317

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

580 Raritan Rd
Roselle, NJ 07203-2446

Mailing address

20 E Sunrise Hwy
Valley Stream, NY 11581-1260
Phone (203) 939-2317

Other names 1

  • Belly Health Medical NJ Doing business as

National Provider Directory

National Provider Directory

Locations

20 E Sunrise Hwy
Valley Stream, NY 11581
Phone (516) 705-4815

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1651449600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774396800000",
    "number": "1487399689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 E SUNRISE HWY",
            "city": "VALLEY STREAM",
            "state": "NY",
            "postal_code": "115811260",
            "telephone_number": "203-939-2317",
            "fax_number": "718-337-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 RARITAN RD",
            "city": "ROSELLE",
            "state": "NJ",
            "postal_code": "072032446",
            "telephone_number": "866-842-3559",
            "fax_number": "718-337-8658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT HEALTH NEW JERSEY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-02",
        "last_updated": "2026-03-25",
        "certification_date": "2026-03-25",
        "status": "A",
        "authorized_official_last_name": "TOLLEN",
        "authorized_official_first_name": "JARED",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "203-939-2317"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Belly Health Medical NJ",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roselle, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2026; 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.