Angelic Health Practice Group
Organization Active NPI Hospice and Palliative Medicine (Internal Medicine) Physician · Pleasantville, NJ
NPI 1700657376 · NPPES record last updated Jan 12, 2024
Key facts
- NPI
- 1700657376
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X
- Legal business name
- ANGELIC HEALTH PRACTICE GROUP
- Practice address
- 8025 Black Horse Pike Ste 501
Pleasantville, NJ 08232-2967 - Phone
- (609) 822-7980
- NPI assigned
- Jan 12, 2024
- Organization subpart
- No
Authorized official
- Name
- Dan Mikus
- Title
- Ceo
- Phone
- (609) 822-7979
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 7
Practitioners 9
-
Anthony Joseph Abbruzzi, D.O.
-
Christine Marie Ablett, APN-C
-
Sheila Lill, MSN, APN
-
Jenna Lynn McNicholl, PA-C
-
Melissa Mordecai, MSN, CRNP
-
Katelin Phelan, CRNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240123001751 | NJ | Part B Supplier - Clinic/Group Practice | 9537510938 |
Receives reassigned benefits from 8 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Pleasantville, NJ |
National Provider Directory
- Tax ID family
- Angelic Palliative Care PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Internal Medicine) Physician |
207RH0002X | Yes |
Addresses
Primary practice location
8025 Black Horse Pike Ste 501
Pleasantville, NJ 08232-2967
Mailing address
8025 Black Horse Pike Ste 501
Pleasantville, NJ 08232-2967
Phone (609) 822-7980
Other names
- Angelic Palliative Care of NJ
NPI Registry JSON
{
"created_epoch": "1705017600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705017600000",
"number": "1700657376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8025 BLACK HORSE PIKE STE 501",
"city": "PLEASANTVILLE",
"state": "NJ",
"postal_code": "082322967",
"telephone_number": "609-822-7980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8025 BLACK HORSE PIKE STE 501",
"city": "PLEASANTVILLE",
"state": "NJ",
"postal_code": "082322967",
"telephone_number": "609-822-7980"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANGELIC HEALTH PRACTICE GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2024-01-12",
"last_updated": "2024-01-12",
"certification_date": "2024-01-12",
"status": "A",
"authorized_official_last_name": "MIKUS",
"authorized_official_first_name": "DAN",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "609-822-7979"
},
"taxonomies": [
{
"code": "207RH0002X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Hospice and Palliative Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Angelic Palliative Care of NJ",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pleasantville, NJ
- Karen Amelung
- Cathy Anderson
- Angelic Health Practice Group
- Angelic Health Practice Group
- Angelic Health Practice Group
- Angelic Health Practice Group
- Angelic Palliative Care
- Angelic Primary Medicine LLC
- Angelicare at Home LLC
- Lawrence J Arch
All providers in Pleasantville, NJ · Hospice and Palliative Medicine (Internal 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 Jan 12, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.