NPIMap

Individual provider Active NPI

David S. Haacker, MD

  • Internal Medicine Physician
  • West Orange, NJ
National Provider Identifier
1902879000
Registry record updated Oct 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA04966800 Issued in NJ
Practice address
443 Northfield Avenue
Suite 301
West Orange, NJ 07052
Phone
(973) 731-0203
Fax
(973) 731-0017
NPI assigned
Feb 9, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2012

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 25MA04966800 NJ Primary

Addresses

Primary practice location

443 Northfield Avenue
Suite 301
West Orange, NJ 07052

Mailing address

PO Box 2621
Secaucus, NJ 07094
Phone (973) 731-0203

Other identifiers 1

IdentifierTypeStateIssuer
2010305MedicaidNJ

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
I20050926000118 NJ Practitioner - Internal Medicine 4880628296 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Rutgers New Jersey Medical School, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hudson MD GroupGroup PAC ID 6103240478, 110 clinicians

Practice addresses (Care Compare)

1625 Anderson Ave
Suite 204
Fort Lee, NJ 07024-2748
Phone (201) 224-0011

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MA04966800NJMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hudson MD Group Internal Medicine CurrentSince Feb 1, 2021 Accepting new patients
Barnabas Health Medical Group PC CurrentSince Feb 16, 2013 Accepting new patients
Barnabas Health Medical Group PC Internal Medicine CurrentSince Feb 16, 2013 Accepting new patients
Neuromedical Center Past Accepting new patients
Abbas a. Shehadeh MD, PA Past Accepting new patients
David W. Lee MD PA PastSince Feb 6, 2007 Accepting new patients
Canterbury at Cedar Grove Care & Rehabilitation Center LLC Past Accepting new patients

Locations

1625 Anderson Ave
Ste 204
Fort Lee, NJ 07024
Phone (201) 224-0011

475 Route 70
Ste 101
Lakewood, NJ 08701
Phone (732) 364-8000

94 Old Short Hills Rd
Livingston, NJ 07039
Phone (973) 322-5400

784 Grand Ave
Ste 201
Ridgefield, NJ 07657
Phone (201) 346-0999

95 Old Short Hills Rd
West Orange, NJ 07052
Phone (973) 322-4800

443 Northfield Ave
Ste 301
West Orange, NJ 07052
Phone (908) 315-5602

Organizations & group practices 7

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 4

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": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1902879000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2621",
            "city": "SECAUCUS",
            "state": "NJ",
            "postal_code": "07094",
            "telephone_number": "973-731-0203",
            "fax_number": "973-731-0017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "443 NORTHFIELD AVENUE",
            "address_2": "SUITE 301",
            "city": "WEST ORANGE",
            "state": "NJ",
            "postal_code": "07052",
            "telephone_number": "973-731-0203",
            "fax_number": "973-731-0017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAACKER",
        "first_name": "DAVID",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA04966800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2010305",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Orange, NJ

Sources for this page

Verify at the official NPI Registry.