Evergreen Medical Group Pc is a medicare enrolled "Physical Medicine & Rehabilitation" provider in River Edge, New Jersey. Their current practice location is
887 Kinderkamack Rd Ste 2, River Edge, New Jersey. You can reach out to their office (for appointments etc.) via phone at
(201) 464-0860.
Evergreen Medical Group Pc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Evergreen Medical Group Pc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1295516409.
Healthcare Provider's Profile
| Full Name | Evergreen Medical Group Pc |
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| Type | Facility |
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| Speciality | Physical Medicine & Rehabilitation |
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| Location | 887 Kinderkamack Rd Ste 2, River Edge, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1295516409
- Provider Enumeration Date: 10/12/2023
- Last Update Date: 02/03/2025
Medicare PECOS Information:
- PECOS PAC ID: 2769929082
- Enrollment ID: O20240805002666
Medical Identifiers
Medical identifiers for Evergreen Medical Group Pc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1295516409 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 111N00000X | Chiropractor | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 208100000X | Physical Medicine & Rehabilitation | (* (Not Available)) | Primary |
| 2086S0129X | Surgery - Vascular Surgery | (* (Not Available)) | Secondary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (* (Not Available)) | Secondary |
| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 363LA2200X | Nurse Practitioner - Adult Health | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| 363LG0600X | Nurse Practitioner - Gerontology | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Secondary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Evergreen Medical Group Pc acts as a billing entity for following providers:
| Provider Name | Grigory Shtender |
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| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
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| Provider Identifiers | NPI Number: 1952316614
PECOS PAC ID: 1850375635
Enrollment ID: I20110729000288 |
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| Provider Name | Jerold H Kaminsky |
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| Provider Type | Practitioner - Chiropractic |
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| Provider Identifiers | NPI Number: 1760569594
PECOS PAC ID: 5193730448
Enrollment ID: I20130313000371 |
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| Provider Name | Agnieszka Golabek |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1346628567
PECOS PAC ID: 0547561011
Enrollment ID: I20151229001598 |
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| Provider Name | Dmitry Gorelik |
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| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
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| Provider Identifiers | NPI Number: 1942375654
PECOS PAC ID: 0345297883
Enrollment ID: I20160122000580 |
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| Provider Name | Kim Giblin |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1215584032
PECOS PAC ID: 0446646251
Enrollment ID: I20220404002337 |
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| Provider Name | Jeanne Rose Magante |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1649569773
PECOS PAC ID: 3476703232
Enrollment ID: I20220815000026 |
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| Provider Name | Jennifer Judith Castaneda-ardizzone |
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| Provider Type | Practitioner - Nurse Practitioner |
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| Provider Identifiers | NPI Number: 1659199065
PECOS PAC ID: 6901330364
Enrollment ID: I20241108000468 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Evergreen Medical Group Pc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Evergreen Medical Group Pc
887 Kinderkamack Rd Ste 2,
River Edge, NJ 07661-2307
Ph: (201) 464-0860 | Evergreen Medical Group Pc
887 Kinderkamack Rd Ste 2,
River Edge, NJ 07661-2307
Ph: (201) 464-0860 |
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