Glorious Ali Shabazz

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

37LC00280000 Issued in NJ

Practice address

300 E 29TH St
Paterson, NJ 07514-1818

Phone

(973) 930-0044

NPI assigned

Feb 3, 2020

Last updated

Feb 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Adult Family Health Services LLC

  • Mental Health Counselor
  • Clifton, NJ
  • NPI 1043786254
  NPD (past)

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

{
    "created_epoch": "1580688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580688000000",
    "number": "1851922397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E 29TH ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141818",
            "telephone_number": "973-930-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 E 29TH ST",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075141818",
            "telephone_number": "973-930-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHABAZZ",
        "first_name": "GLORIOUS",
        "middle_name": "ALI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-03",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00280000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "other",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "other",
            "address_1": "300 E 29th St",
            "city": "Paterson",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "075141818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wanda Lynn Sermon, LPN
• Georgina Maria Sesana, MD
• Monique G. Severe, M.D.
• Rehan Hassanin Seyam
• Donald Sgroi, M.D.
• Nichol Shabazz, PMHNP-BC
• Fady Fawzy Shafeek, MD
• Abhi Shah, PHARM.D
• Bindesh Kiran Shah, RPH
• Dinesh H Shah, M.D.

• Addiction (Substance Use Disorder) Counselor in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Addiction (Substance Use Disorder) Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.