NPIMap

Organization Active NPI

Medical Service Professionals of NJ LLC

Doing business as Clover Home Care

  • Geriatric Medicine (Internal Medicine) Physician
  • Lyndhurst, NJ
National Provider Identifier
1972044923
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
MEDICAL SERVICE PROFESSIONALS OF NJ LLC
Doing business as
Clover Home Care
Practice address
125 Chubb Ave
Suite 100-S
Lyndhurst, NJ 07071-3504
Phone
(201) 559-7600
NPI assigned
Mar 10, 2017
Last updated
Oct 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

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

Authorized official

Name
Kelly Fontana
Title
Director of Clinical Compliance
Phone
(631) 457-9145

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) Physician 207QG0300X
Geriatric Medicine (Internal Medicine) Physician 207RG0300X Primary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X

Addresses

Primary practice location

125 Chubb Ave
Suite 100-S
Lyndhurst, NJ 07071-3504

Mailing address

125 Chubb Ave Ste 100S
Lyndhurst, NJ 07071-3504

Other names 1

  • Clover Home Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170927002286 NJ Part B Supplier - Clinic/Group Practice 9931473139 Receives reassigned benefits from 71 practitioners
Practice locations: Lyndhurst, NJ

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
31D2136414Medical Service Professionals of NJ, LLC125 Chubb Ave Suite 100, Lyndhurst, NJ 07071Certificate of waiverDec 13, 2027

National Provider Directory

National Provider Directory

Locations

30 Montgomery St
Fl 15
Jersey City, NJ 07302
Phone (551) 247-1029

125 Chubb Ave
Lyndhurst, NJ 07071
Phone (201) 559-7600

125 Chubb Ave
Ste 100S
Lyndhurst, NJ 07071
Phone (201) 559-7600

Practitioners & affiliated clinicians

Practitioners 75

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 75

NPI Registry JSON

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

{
    "created_epoch": "1489104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1972044923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 CHUBB AVE STE 100S",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070713504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CHUBB AVE",
            "address_2": "SUITE 100-S",
            "city": "LYNDHURST",
            "state": "NJ",
            "postal_code": "070713504",
            "telephone_number": "201-559-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL SERVICE PROFESSIONALS OF NJ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-10",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "FONTANA",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL COMPLIANCE",
        "authorized_official_telephone_number": "631-457-9145"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clover Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clover Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lyndhurst, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.