Individual provider Active NPI

Fuad M Kiblawi, M.D.

  • Pediatric Cardiology Physician
  • Elmwood Park, NJ
National Provider Identifier
1710065107
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
MA72786 Issued in NJ
Practice address
1 Broadway
Suite 203
Elmwood Park, NJ 07407-1842
Phone
(973) 569-6250
Fax
(973) 569-6270
NPI assigned
Nov 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X MA72786 NJ Primary

Addresses

Primary practice location

1 Broadway
Suite 203
Elmwood Park, NJ 07407-1842

Mailing address

1 Broadway
Suite 203
Elmwood Park, NJ 07407-1842
Phone (973) 569-6250

Other identifiers 1

IdentifierTypeStateIssuer
8857504MedicaidNJ

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
I20180509002764 NJ Practitioner - Cardiovascular Disease (Cardiology) 8921362435 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pediatric Cardiology Associates PCGroup PAC ID 5799768875, 3 clinicians

Practice addresses (Care Compare)

1 Broadway
Suite 203
Elmwood Park, NJ 07407-1844
Phone (973) 569-6250

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA72786NJMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pediatric Cardiology Associates PC CurrentSince Sep 17, 2024 Accepting new patients
St Josephs Medical Group PC CurrentSince Aug 1, 2023 Accepting new patients

Locations

1 Broadway
Ste 203
Elmwood Park, NJ 07407
Phone (973) 569-6250

11 Getty Ave
Paterson, NJ 07503

703 Main St
#G
Paterson, NJ 07503
Phone (973) 754-6331

11 Getty Ave
Paterson, NJ 07503
Phone (973) 754-4200

703 Main St
Paterson, NJ 07503
Phone (973) 754-2240

220 Hamburg Tpke
Ste 203
Wayne, NJ 07470

Interoperability endpoints

  • Direct secure messaging: fuad.kiblawi@pedcard.eclinicaldirectplus.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710065107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BROADWAY",
            "address_2": "SUITE 203",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071842",
            "telephone_number": "973-569-6250",
            "fax_number": "973-569-6270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 BROADWAY",
            "address_2": "SUITE 203",
            "city": "ELMWOOD PARK",
            "state": "NJ",
            "postal_code": "074071842",
            "telephone_number": "973-569-6250",
            "fax_number": "973-569-6270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBLAWI",
        "first_name": "FUAD",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "NJ",
            "license": "MA72786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8857504",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elmwood Park, NJ

Sources for this page

Verify at the official NPI Registry.