Individual provider Active NPI

Bella Fardzinova

  • Gerontology Nurse Practitioner
  • Egg Harbor Township, NJ
National Provider Identifier
1669920245
Registry record updated Sep 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
26NJ00597100 Issued in NJ
Practice address
105 Daphne Rd
Egg Harbor Township, NJ 08234-6121
Phone
(609) 350-3572
NPI assigned
Sep 13, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 26NJ00597100 NJ Primary

Addresses

Primary practice location

105 Daphne Rd
Egg Harbor Township, NJ 08234-6121

Mailing address

105 Daphne Rd
Egg Harbor TWP, NJ 08234-6121
Phone (609) 350-3572

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171116002180 NJ Practitioner - Nurse Practitioner 9830455336 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Atlanticare Physician Group PAGroup PAC ID 8527953660, 506 clinicians

Practice addresses (Care Compare)

2500 English Creek Ave
BLDG 800
Egg Harbor Township, NJ 08234-5549
Phone (609) 407-2332

Hospital & facility affiliations

  • Atlanticare Regional Medical Center - City Campus Hospital, Atlantic City, NJ, CCN 310064

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ00597100NJMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Atlanticare Physician Group, PA CurrentSince May 17, 2019 Accepting new patients
Atlanticare Physician Group PA CurrentSince May 17, 2019 Accepting new patients
Atlanticare Physician Group Past Accepting new patients

Locations

106 Court House South Dennis Rd
Ste 200
Cape May Court House, NJ 08210
Phone (609) 407-2332

2500 English Creek Ave
Ste 800
Egg Hbr Twp, NJ 08234
Phone (609) 407-2277

459 Route 9 S
Little Egg Harbor Twp, NJ 08087
Phone (609) 340-7815

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1473724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473724800000",
    "number": "1669920245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 DAPHNE RD",
            "city": "EGG HARBOR TWP",
            "state": "NJ",
            "postal_code": "082346121",
            "telephone_number": "609-350-3572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 DAPHNE RD",
            "city": "EGG HARBOR TOWNSHIP",
            "state": "NJ",
            "postal_code": "082346121",
            "telephone_number": "609-350-3572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARDZINOVA",
        "first_name": "BELLA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-13",
        "last_updated": "2016-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00597100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Egg Harbor Township, NJ

Sources for this page

Verify at the official NPI Registry.