NPIMap

Organization Active NPI

Evergreen Physicians of North Jersey, PC

  • Internal Medicine Physician
  • Rochelle Park, NJ
National Provider Identifier
1912956152
Registry record updated Dec 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MB06960500 Issued in NJ
Legal business name
EVERGREEN PHYSICIANS OF NORTH JERSEY, PC
Practice address
96 Parkway
Evergreen Physicians of North Jersey, PC
Rochelle Park, NJ 07662-4200
Phone
(973) 450-2540
Fax
(919) 425-0478
NPI assigned
May 6, 2006
Last updated
Dec 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2020

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

Authorized official

Name
Kathy Kondas
Title
Officer
Phone
(973) 251-1132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MB06960500 NJ Primary

Addresses

Primary practice location

96 Parkway
Evergreen Physicians of North Jersey, PC
Rochelle Park, NJ 07662-4200

Mailing address

3114 Croasdaile Dr Ste 200
Evergreen Physicians of North Jersey, PC
Durham, NC 27705-2508
Phone (954) 838-2371

Other identifiers 1

IdentifierTypeStateIssuer
0102091MedicaidNJ

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1501 NW 49th St
Ste 140
Ft Lauderdale, FL 33309
Phone (877) 751-1157

96 Parkway
Spc Hosp
Rochelle Park, NJ 07662
Phone (973) 450-2540

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1146873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608595200000",
    "number": "1912956152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3114 CROASDAILE DR STE 200",
            "address_2": "EVERGREEN PHYSICIANS OF NORTH JERSEY, PC",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277052508",
            "telephone_number": "954-838-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "96 PARKWAY",
            "address_2": "EVERGREEN PHYSICIANS OF NORTH JERSEY, PC",
            "city": "ROCHELLE PARK",
            "state": "NJ",
            "postal_code": "076624200",
            "telephone_number": "973-450-2540",
            "fax_number": "919-425-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHYSICIANS OF NORTH JERSEY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-06",
        "last_updated": "2020-12-22",
        "certification_date": "2020-12-22",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MB06960500",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102091",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochelle Park, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.