| Clifton Family Outpatient Clinic | |
|
777 Bloomfield Ave Ste B Suite B Clifton NJ 07012-1242 | |
| (973) 594-0125 | |
| Not Available |
| Full Name | Clifton Family Outpatient Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 777 Bloomfield Ave Ste B, Clifton, New Jersey |
| Authorized Official Name and Position | James J Rose (CFO) |
| Authorized Official Contact | 6094060100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clifton Family Outpatient Clinic 20 Scotch Rd Ewing NJ 08628-2503 Ph: (609) 406-0100 | Clifton Family Outpatient Clinic 777 Bloomfield Ave Ste B Suite B Clifton NJ 07012-1242 Ph: (973) 594-0125 |
| NPI Number | 1356454615 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 04/09/2009 |
| Medicare PECOS PAC ID | 8820983117 |
|---|---|
| Medicare Enrollment ID | O20040217000005 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356454615 | NPI | - | NPPES |
| 00144001 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 500049704 (New Jersey) | Primary |
| Provider Name | Shani Stein |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1023207263 PECOS PAC ID: 6507940145 Enrollment ID: I20080221000204 |
| Provider Name | Hayman Rambaran |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1639295470 PECOS PAC ID: 9234266891 Enrollment ID: I20100430000085 |
| Provider Name | Raymond Chong |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720239023 PECOS PAC ID: 7315136249 Enrollment ID: I20110107000701 |
| Provider Name | Tolulope Olajumoke Kolawole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598218042 PECOS PAC ID: 2365725488 Enrollment ID: I20170215000214 |
| Provider Name | Louise Gabriele |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801331434 PECOS PAC ID: 2264703636 Enrollment ID: I20170802003401 |
| Provider Name | Emmanuel O Anyanwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912417130 PECOS PAC ID: 2264792852 Enrollment ID: I20180130000644 |
| Provider Name | Carlo G Salgado Russo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346677564 PECOS PAC ID: 4587994090 Enrollment ID: I20190926001037 |
| Provider Name | Obiageri I Anyanwu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073165767 PECOS PAC ID: 2365860731 Enrollment ID: I20200916002646 |
| Provider Name | Larry I Rogers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811582182 PECOS PAC ID: 5991113573 Enrollment ID: I20210420001937 |
| Provider Name | Blessing Okarter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073241188 PECOS PAC ID: 9931564283 Enrollment ID: I20230420002140 |
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