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85 N 14th St East Orange NJ 07017-5112 | |
| (973) 571-9090 | |
| (973) 556-1194 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 85 N 14th St, East Orange, New Jersey |
| Authorized Official Name and Position | Ronald Croix Coppage (PRESIDENT) |
| Authorized Official Contact | 9735719090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
85 N 14th St East Orange NJ 07017-5112 Ph: (973) 571-9090 | 85 N 14th St East Orange NJ 07017-5112 Ph: (973) 571-9090 |
| NPI Number | 1588220552 |
|---|---|
| Provider Enumeration Date | 05/15/2019 |
| Last Update Date | 01/21/2025 |
| Certification Date | 01/21/2025 |
| Medicare PECOS PAC ID | 2769831155 |
|---|---|
| Medicare Enrollment ID | O20231211002246 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588220552 | NPI | - | NPPES |
| Provider Name | Calvin C George |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841628377 PECOS PAC ID: 5991924268 Enrollment ID: I20140918001115 |
| Provider Name | Azuka M Ofodike |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922422617 PECOS PAC ID: 8325367931 Enrollment ID: I20150504001144 |
| Provider Name | Melvin H Chan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508271313 PECOS PAC ID: 8527358571 Enrollment ID: I20160602001573 |
| Provider Name | Hamida O Yaqoobi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053954339 PECOS PAC ID: 7214360916 Enrollment ID: I20191211001485 |
| Provider Name | Natasha Caruth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952920621 PECOS PAC ID: 8022424886 Enrollment ID: I20210303001274 |
| Provider Name | Chenelle Dudley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306017868 PECOS PAC ID: 9739538133 Enrollment ID: I20231211002393 |
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