Individual provider Active NPI

Aderemi Soyombo, M.D.

  • Cardiovascular Disease Physician
  • Fair Lawn, NJ
National Provider Identifier
1649437856
Registry record updated Sep 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
25MA08557600 Issued in NJ
Practice address
22-18 Broadway
Suite 201
Fair Lawn, NJ 07410-3016
Phone
(201) 475-5050
Fax
(201) 475-5522
NPI assigned
May 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 25MA08557600 NJ Primary

Addresses

Primary practice location

22-18 Broadway
Suite 201
Fair Lawn, NJ 07410-3016

Mailing address

22-18 Broadway
Suite 201
Fair Lawn, NJ 07410-3016
Phone (201) 475-5050

Other identifiers 1

IdentifierTypeStateIssuer
0207021MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090903000292 NJ Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9234284829 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Associates of Englewood, PC CurrentSince Jul 30, 2016 Accepting new patients

Locations

22-18 Broadway
Ste 201
Fair Lawn, NJ 07410

24 Elm St
Ste 203
Harrington Pk, NJ 07640
Phone (201) 784-0123

308 Willow Ave
Hoboken, NJ 07030
Phone (201) 418-1574

150 Warren St
Jersey City, NJ 07302
Phone (201) 309-3000

Interoperability endpoints

  • Direct secure messaging: aderemi.soyombo@direct.carepointhealth.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1210896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347840000000",
    "number": "1649437856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22-18 BROADWAY",
            "address_2": "SUITE 201",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103016",
            "telephone_number": "201-475-5050",
            "fax_number": "201-475-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22-18 BROADWAY",
            "address_2": "SUITE 201",
            "city": "FAIR LAWN",
            "state": "NJ",
            "postal_code": "074103016",
            "telephone_number": "201-475-5050",
            "fax_number": "201-475-5522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOYOMBO",
        "first_name": "ADEREMI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-16",
        "last_updated": "2012-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NJ",
            "license": "25MA08557600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0207021",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fair Lawn, NJ

Sources for this page

Verify at the official NPI Registry.