| Ennoble Hc Nj Pc | |
|
2 University Plz Hackensack NJ 07601-6202 | |
| (973) 435-9463 | |
| Not Available |
| Full Name | Ennoble Hc Nj Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2 University Plz, Hackensack, New Jersey |
| Authorized Official Name and Position | Kushabhadra Das (CEO) |
| Authorized Official Contact | 8628129010 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ennoble Hc Nj Pc 2 University Plaza Drive Suite 204 Hackensack NJ 07601 Ph: (973) 241-1356 | Ennoble Hc Nj Pc 2 University Plz Hackensack NJ 07601-6202 Ph: (973) 435-9463 |
| NPI Number | 1306500764 |
|---|---|
| Provider Enumeration Date | 10/22/2021 |
| Last Update Date | 11/08/2022 |
| Medicare PECOS PAC ID | 0345638185 |
|---|---|
| Medicare Enrollment ID | O20211027000609 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306500764 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Lael E Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730494980 PECOS PAC ID: 1759560279 Enrollment ID: I20110128000757 |
| Provider Name | Theresa Mary Cleary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548737505 PECOS PAC ID: 3870832033 Enrollment ID: I20190305003061 |
| Provider Name | Paul Mensah |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629695036 PECOS PAC ID: 1052737459 Enrollment ID: I20200817001067 |
| Provider Name | Caroline Wilkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104474394 PECOS PAC ID: 0648653162 Enrollment ID: I20220816003924 |
| Provider Name | Thomas Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285632950 PECOS PAC ID: 7214997014 Enrollment ID: I20230522000001 |
| Provider Name | Kettia Delisfort |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790481596 PECOS PAC ID: 0345608048 Enrollment ID: I20230627002238 |
| Provider Name | Nafisa Chowdhury |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386354892 PECOS PAC ID: 4880034578 Enrollment ID: I20240429001284 |
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