Individual provider Active NPI

Dean Gabriel Imbemba, PA-C

  • Physician Assistant
  • Linden, NJ
National Provider Identifier
1861065153
Registry record updated Aug 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
25MP00636900 Issued in NJ
Practice address
210 W Saint Georges Ave FL 2
Linden, NJ 07036-3900
Phone
(908) 486-1111
NPI assigned
Jul 23, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 25MP00636900 NJ Primary

Addresses

Primary practice location

210 W Saint Georges Ave FL 2
Linden, NJ 07036-3900

Mailing address

210 W Saint Georges Ave FL 2
Linden, NJ 07036-3900

Other practice location 1

1139 Raritan Rd Ste 202
Clark, NJ 07066-1344
Phone (908) 486-1111

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210909002408 NJ Practitioner - Physician Assistant 6709282155 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthonj LLCGroup PAC ID 6800225178, 302 clinicians

Practice addresses (Care Compare)

210 W Saint Georges Ave FL
2 Union County Orthopaedic Group
Linden, NJ 07036-3900
Phone (908) 486-1111

5 Plainsboro Rd
Plainsboro, NJ 08536-1915
Phone (609) 924-8131

Hospital & facility affiliations

  • Robert Wood Johnson University Hospital at Rahway Hospital, Rahway, NJ, CCN 310024
  • Trinitas Regional Medical Center Hospital, Elizabeth, NJ, CCN 310027
  • Kessler Rehab Center Inpatient rehabilitation facility, West Orange, NJ, CCN 313025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
25MP00636900NJMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthonj LLC CurrentSince Aug 10, 2021 Accepting new patients
Orthonj LLC CurrentSince Aug 10, 2021 Accepting new patients

Locations

1139 Raritan Rd
Ste 202
Clark, NJ 07066
Phone (732) 388-1761

210 W Saint Georges Ave
Fl 2
Linden, NJ 07036
Phone (908) 486-1111

2315 Route 34
Manasquan, NJ 08736
Phone (732) 974-0404

5 Plainsboro Rd
Ste 100
Plainsboro, NJ 08536
Phone (609) 750-1600

2333 Morris Ave
Ste D109
Union, NJ 07083
Phone (908) 486-4400

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1861065153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W SAINT GEORGES AVE FL 2",
            "city": "LINDEN",
            "state": "NJ",
            "postal_code": "070363900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W SAINT GEORGES AVE FL 2",
            "city": "LINDEN",
            "state": "NJ",
            "postal_code": "070363900",
            "telephone_number": "908-486-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1139 Raritan Rd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Clark",
            "state": "NJ",
            "postal_code": "070661344",
            "country_code": "US",
            "telephone_number": "908-486-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IMBEMBA",
        "first_name": "DEAN",
        "middle_name": "GABRIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00636900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Linden, NJ

Sources for this page

Verify at the official NPI Registry.