| Meditelecare Of New Jersey Llc | |
|
100 Charles Ewing Blvd Ewing NJ 08628-3454 | |
| (860) 788-6404 | |
| (860) 829-0495 |
| Full Name | Meditelecare Of New Jersey Llc |
|---|---|
| Speciality | Psychologist |
| Location | 100 Charles Ewing Blvd, Ewing, New Jersey |
| Authorized Official Name and Position | Andrea Godfrey (CREDENTIALING & ENROLLMENT MANAGER) |
| Authorized Official Contact | 8602742418 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Meditelecare Of New Jersey Llc Po Box 1595 Middletown CT 06457-8095 Ph: (860) 788-6404 | Meditelecare Of New Jersey Llc 100 Charles Ewing Blvd Ewing NJ 08628-3454 Ph: (860) 788-6404 |
| NPI Number | 1639750797 |
|---|---|
| Provider Enumeration Date | 04/19/2021 |
| Last Update Date | 09/04/2024 |
| Certification Date | 09/04/2024 |
| Medicare PECOS PAC ID | 5496164360 |
|---|---|
| Medicare Enrollment ID | O20210505000766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639750797 | NPI | - | NPPES |
| Provider Name | Hadley A Noble |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1043697725 PECOS PAC ID: 3173587961 Enrollment ID: I20041111000978 |
| Provider Name | Padmavathy Kurra |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205949468 PECOS PAC ID: 5193712677 Enrollment ID: I20050316000589 |
| Provider Name | Tadd L Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093032690 PECOS PAC ID: 4183811524 Enrollment ID: I20101210000057 |
| Provider Name | Glenn Ferguson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922391994 PECOS PAC ID: 3870771496 Enrollment ID: I20110630000539 |
| Provider Name | Victoria I Munoz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710007810 PECOS PAC ID: 2062670961 Enrollment ID: I20120223000559 |
| Provider Name | Vladislav Zelondzhev |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639307945 PECOS PAC ID: 6103080742 Enrollment ID: I20120612000513 |
| Provider Name | Regina B Glisson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245576834 PECOS PAC ID: 7214175256 Enrollment ID: I20130603000206 |
| Provider Name | Michele De Lorenzo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689839730 PECOS PAC ID: 7416186200 Enrollment ID: I20140127000143 |
| Provider Name | Jamie Grimes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972884518 PECOS PAC ID: 1153637269 Enrollment ID: I20150904000182 |
| Provider Name | Nancy Frederic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063716769 PECOS PAC ID: 9830317205 Enrollment ID: I20151208001239 |
| Provider Name | Mahip Gupta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366814022 PECOS PAC ID: 3274834577 Enrollment ID: I20151210000555 |
| Provider Name | Kristina Flores |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407293863 PECOS PAC ID: 6305162728 Enrollment ID: I20160512000668 |
| Provider Name | Vincent Basile |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477953883 PECOS PAC ID: 9931421716 Enrollment ID: I20170503000736 |
| Provider Name | Marie Garon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508391046 PECOS PAC ID: 8022385699 Enrollment ID: I20170602000141 |
| Provider Name | Olanda Dreher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144530361 PECOS PAC ID: 5496014888 Enrollment ID: I20180110000914 |
| Provider Name | Megan Florio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194258806 PECOS PAC ID: 3375898547 Enrollment ID: I20180613000306 |
| Provider Name | Eileen Stengel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851688691 PECOS PAC ID: 1355563016 Enrollment ID: I20180904001079 |
| Provider Name | Luis A Guerreiro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1467597666 PECOS PAC ID: 0749531184 Enrollment ID: I20180924001642 |
| Provider Name | Abelardo Javier Lobo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972070811 PECOS PAC ID: 8820334618 Enrollment ID: I20190116000601 |
| Provider Name | Mary V Larsen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710065016 PECOS PAC ID: 5890035133 Enrollment ID: I20190322000903 |
| Provider Name | Christine E Powell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245896059 PECOS PAC ID: 4284964396 Enrollment ID: I20191002001876 |
| Provider Name | Norrel R Sainsott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750939575 PECOS PAC ID: 7113258997 Enrollment ID: I20191009000462 |
| Provider Name | Christiana Nduka-onwuka |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962027979 PECOS PAC ID: 9032526827 Enrollment ID: I20210323001017 |
| Provider Name | Ijeoma Christiana Onyeagocha |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851905822 PECOS PAC ID: 0941617237 Enrollment ID: I20210405000223 |
| Provider Name | Esohe Obasohan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801476932 PECOS PAC ID: 3173922929 Enrollment ID: I20210527000084 |
| Provider Name | Kelly Rice |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588336234 PECOS PAC ID: 4981092715 Enrollment ID: I20211028000986 |
| Provider Name | Gabriell Budoff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265911473 PECOS PAC ID: 2062764772 Enrollment ID: I20220811001392 |
| Provider Name | Asia Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760088058 PECOS PAC ID: 1759765423 Enrollment ID: I20220829003808 |
| Provider Name | Rachene Roanna Alexander |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760068159 PECOS PAC ID: 3476937194 Enrollment ID: I20220830002251 |
| Provider Name | Leona Nobles-harrington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285280529 PECOS PAC ID: 5193159861 Enrollment ID: I20221006002167 |
| Provider Name | Lauren Mcmiller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1093374498 PECOS PAC ID: 2961737937 Enrollment ID: I20221013000028 |
| Provider Name | Dionne Smith |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902846926 PECOS PAC ID: 5496790602 Enrollment ID: I20221202001892 |
| Provider Name | Timothy Davis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1740346253 PECOS PAC ID: 7810218658 Enrollment ID: I20230207003215 |
| Provider Name | Lauren Linn |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1023780681 PECOS PAC ID: 9234527581 Enrollment ID: I20230224001044 |
| Provider Name | Denise Huebler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699490771 PECOS PAC ID: 8729453352 Enrollment ID: I20230412001278 |
| Provider Name | Jeisy Mitre |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790321354 PECOS PAC ID: 5294190385 Enrollment ID: I20230425000365 |
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