Active NPI
Iconic Medical and Wellness Centers
- Health Service Clinic/Center
- Mendham, NJ
National Provider Identifier
1831789338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Clinic/Center
- Legal business name
- ICONIC MEDICAL AND WELLNESS CENTERS
- Practice address
- 5 Cold Hill Rd S Ste 26J
Mendham, NJ 07945-3208 - Phone
- (973) 531-6377
- NPI assigned
- Jan 19, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Maria Korogodsky, PA-C
- Title
- Physician Assistant
- Phone
- (908) 403-1160
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Primary |
Addresses
Primary practice location
5 Cold Hill Rd S Ste 26J
Mendham, NJ 07945-3208
Mailing address
5 Cold Hill Rd S Ste 26J
Mendham, NJ 07945-3208
Phone (973) 531-6377
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Mendham | Other |
National Provider Directory
National Provider DirectoryLocations
5 Cold Hill Rd S
Ste 26J
Mendham, NJ 07945
Phone (973) 531-6377
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Newark, NJ
- NPI 1114177441
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611014400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1611014400000",
"number": "1831789338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 COLD HILL RD S STE 26J",
"city": "MENDHAM",
"state": "NJ",
"postal_code": "079453208",
"telephone_number": "973-531-6377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5 COLD HILL RD S STE 26J",
"city": "MENDHAM",
"state": "NJ",
"postal_code": "079453208",
"telephone_number": "973-531-6377"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ICONIC MEDICAL AND WELLNESS CENTERS",
"organizational_subpart": "NO",
"enumeration_date": "2021-01-19",
"last_updated": "2021-01-19",
"certification_date": "2021-01-19",
"status": "A",
"authorized_official_last_name": "KOROGODSKY",
"authorized_official_first_name": "MARIA",
"authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
"authorized_official_telephone_number": "908-403-1160",
"authorized_official_credential": "PA-C"
},
"taxonomies": [
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Mendham",
"affiliation": "N",
"endpointDescription": "office",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "Mendham",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Mendham",
"address_1": "5 Cold Hill Rd S Ste 26J",
"city": "Mendham",
"state": "NJ",
"country_code": "US",
"postal_code": "079453208",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Mendham, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.