Agile Infusion Medicine PC
Organization Active NPI Primary Care Clinic/Center · Hackensack, NJ
NPI 1972382018 · NPPES record last updated Dec 6, 2023
Key facts
- NPI
- 1972382018
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- Legal business name
- AGILE INFUSION MEDICINE PC
- Practice address
- 5 Summit Ave Ste 204
Hackensack, NJ 07601-1271 - Phone
- (201) 751-2202
- Fax
- (201) 266-0437
- NPI assigned
- Sep 27, 2023
- Organization subpart
- No
Authorized official
- Name
- Dr. Jonathan Wiesen, MD
- Title
- Owner
- Phone
- (631) 759-9866
Practitioners 2
-
Jonathan Wiesen, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in NJ, NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231226000969 | NJ | Part B Supplier - Clinic/Group Practice | 5597115097 |
Receives reassigned benefits from 2 practitioners Practice locations: Edison, NJ; Hackensack, NJ; Lakewood, NJ |
| O20240201000328 | NY | Part B Supplier - Clinic/Group Practice | 5597115097 |
Receives reassigned benefits from 1 practitioner Practice locations: Brooklyn, NY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pulmonary Disease Physician |
207RP1001X | |||
| Primary Care Clinic/Center | 261QP2300X | Yes |
Addresses
Primary practice location
5 Summit Ave Ste 204
Hackensack, NJ 07601-1271
Mailing address
668 N Forest Dr
Teaneck, NJ 07666-2047
Phone (201) 751-2202
Other practice location 1
668 N Forest Dr
Teaneck, NJ 07666-2047
Phone (631) 759-9866
Other providers in Hackensack, NJ
- Aero Ambulance Service, Inc.
- Aesthetic Dental Center of Hackensack LLC
- Kristina Aganova
- Jay Agarwal
- Aakash Aggarwal
- Harry Agress Jr.
- Kimberly C Agresta
- Angela Suguey Aguilar
- Michelle Tiffany Rayoso Aguilar
- Amanda Alyse Ahearn
All providers in Hackensack, NJ · Primary Care Clinic/Center 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 Dec 6, 2023. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.