Medical Service Professionals of NJ LLC
Organization Active NPI Geriatric Medicine (Internal Medicine) Physician · Lyndhurst, NJ
NPI 1972044923 · NPPES record last updated Oct 12, 2022
Key facts
- NPI
- 1972044923
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician 207RG0300X
- Legal business name
- MEDICAL SERVICE PROFESSIONALS OF NJ LLC
- Practice address
- 125 Chubb Ave
Suite 100-S
Lyndhurst, NJ 07071-3504 - Phone
- (201) 559-7600
- NPI assigned
- Mar 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Kelly Fontana
- Title
- Director of Clinical Compliance
- Phone
- (631) 457-9145
Practitioners 75
-
Lindsay Abrams, LCSW
-
Yanitza Acevedo, NP-C
-
Tracy Anselmo, APN
-
Aurora Aranzazu, FNP-C
-
Tatiana Carmona, LCSW
-
Gwen Dodd Lee, APN-C
-
Kathryn Dore, APN
-
Sarah M EMS, APN
-
Nicole S. Glover, FNP-BC
-
Edward Charles Hatton, MSN, NP
-
Christina Soon Heo, AGNP-C
-
Karintha Holifield, M.D.
-
Ebele Ilogu, MSN,APN-C
-
Rodah W Kimani, APN
-
Susan Heather Lake, AGNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 31D2136414 | Medical Service Professionals of NJ, LLC | Certificate of waiver | Dec 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170927002286 | NJ | Part B Supplier - Clinic/Group Practice | 9931473139 |
Receives reassigned benefits from 71 practitioners Practice locations: Lyndhurst, NJ |
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Family Medicine) Physician |
207QG0300X | |||
| Hospice and Palliative Medicine (Family Medicine) Physician |
207QH0002X | |||
| Geriatric Medicine (Internal Medicine) Physician |
207RG0300X | Yes | ||
| 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
- Clover Home Care
Other providers in Lyndhurst, NJ
- Schuyler McIlvaine
- Regina M McKenna
- Peter McMullen
- MDX Medical Inc.
- Meadowlands Chiropractic Center, P.a.
- Marina Megalla
- Allison Mejia
- Maddisen Melley
- Stephanie Melli
- Metro Anesthesia Associates LLC
All providers in Lyndhurst, NJ · Geriatric Medicine (Internal Medicine) Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.