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is a Nurse Practitioner - Family based in Newark, New Jersey. is licensed to practice in * (Not Available) (license number ) and their current practice location is 1120-1122 South Orange Avenue, Newark, New Jersey. It can be reached at their office (for appointments etc.) via phone at (201) 618-1472.

NPI number for is 1710525662 and their current mailing address is 78 Kenmore Ave, Newark, New Jersey. does not participate in medicare program and thus does not accept medicare assignments. The facility's NPI Number is 1710525662.

Contact Information

1120-1122 South Orange Avenue,
Newark, NJ 07106
(201) 618-1472
Not Available

Map and Direction




Healthcare Provider's Profile

Full Name
TypeFacility
SpecialityNurse Practitioner - Family
Location1120-1122 South Orange Avenue, Newark, New Jersey
Accepts Medicare AssignmentsDoes not participate in Medicare Program. The facility may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1710525662
  • Provider Enumeration Date: 12/11/2019
  • Last Update Date: 09/01/2021

Medical Identifiers

Medical identifiers for such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1710525662NPI-NPPES
0143533620MedicaidNJ

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
133V00000XDietitian, Registered (* (Not Available))Secondary
163WD0400XRegistered Nurse - Diabetes Educator (* (Not Available))Secondary
261QH0100XClinic/center - Health Service (* (Not Available))Secondary
363LF0000XNurse Practitioner - Family (* (Not Available))Primary

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. is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address

78 Kenmore Ave,
Newark, NJ 07106-1026

Ph: (201) 618-1472
1120-1122 South Orange Avenue,
Newark, NJ 07106

Ph: (201) 618-1472

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.