NPIMap

Individual provider Active NPI

Eli S Djebiyan, MD

  • Internal Medicine Physician
  • Englewood, NJ
National Provider Identifier
1841215969
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA06812100 Issued in NJ
Practice address
140 Grand Ave
Englewood, NJ 07631-6581
Phone
(201) 569-9010
Fax
(201) 569-9063
NPI assigned
Jul 12, 2006
Last updated
Jun 25, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA06812100 NJ Primary

Addresses

Primary practice location

140 Grand Ave
Englewood, NJ 07631-6581

Mailing address

140 Grand Ave
Englewood, NJ 07631-6581
Phone (201) 569-9010

Other identifiers 1

IdentifierTypeStateIssuer
7706901MedicaidNJ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090603000460 NJ Practitioner - Internal Medicine 7618027103 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excelcare Medical Associates PAGroup PAC ID 4284647868, 200 clinicians

Practice addresses (Care Compare)

140 Grand Ave
Suite 3
Englewood, NJ 07631-6582
Phone (201) 569-9010

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA06812100NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Group of Englewood, Inc Specialist CurrentSince Mar 19, 2009 Accepting new patients
Excelcare Medical Associates, PA Internal Medicine CurrentSince Jun 1, 2024 Accepting new patients
Mr of Teaneck LLC Past Accepting new patients
Holy Name Medical Center Inc. Past Accepting new patients
St. Vincent's Midtown Hospital Past Accepting new patients
HMH Hospitals Corporation Past Accepting new patients
Family of Caring at Teaneck LLC Past Accepting new patients
Complete Care at Regent LLC Past Accepting new patients
600 Kinderkamack Road Operating Company, LLC Past Accepting new patients

Locations

140 Grand Ave
Englewood, NJ 07631
Phone (201) 569-7672

140 Grand Ave
Ste 3
Englewood, NJ 07631
Phone (201) 569-9010

3 University Plz
Ste 205
Hackensack, NJ 07601

1 W Ridgewood Ave
Ste 203
Paramus, NJ 07652
Phone (201) 312-5243

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

Organizations & group practices 10

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.

Hospital & facility affiliations 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1841215969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 GRAND AVE",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076316581",
            "telephone_number": "201-569-9010",
            "fax_number": "201-569-9063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 GRAND AVE",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076316581",
            "telephone_number": "201-569-9010",
            "fax_number": "201-569-9063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DJEBIYAN",
        "first_name": "ELI",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA06812100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7706901",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.