| Im&gp | |
|
1414 Main Ave Suite B Clifton NJ 07011-2157 | |
| (973) 253-6000 | |
| (973) 253-6009 |
| Full Name | Im&gp |
|---|---|
| Speciality | Clinic/Center |
| Location | 1414 Main Ave, Clifton, New Jersey |
| Authorized Official Name and Position | Waleed S Lashin (PRESIDENT) |
| Authorized Official Contact | 9732536000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Im&gp 1414 Main Ave Suite B Clifton NJ 07011-2157 Ph: (973) 253-6000 | Im&gp 1414 Main Ave Suite B Clifton NJ 07011-2157 Ph: (973) 253-6000 |
| NPI Number | 1598803264 |
|---|---|
| Provider Enumeration Date | 02/02/2007 |
| Last Update Date | 08/26/2010 |
| Medicare PECOS PAC ID | 5597767426 |
|---|---|
| Medicare Enrollment ID | O20070206000577 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598803264 | NPI | - | NPPES |
| 0064394 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MA07809300 (New Jersey) | Primary |
| Provider Name | Waleed S Lashin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477590644 PECOS PAC ID: 5991745648 Enrollment ID: I20050512000024 |
| Provider Name | Rachel M Thomas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649392218 PECOS PAC ID: 3870675077 Enrollment ID: I20080128000130 |
| Provider Name | Nevine Awad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427440148 PECOS PAC ID: 2769703958 Enrollment ID: I20150529002024 |
| Provider Name | Zaida Barreto |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235248980 PECOS PAC ID: 9234443268 Enrollment ID: I20160722000059 |
| Provider Name | Edith Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346588183 PECOS PAC ID: 5991090706 Enrollment ID: I20160818000294 |
| Provider Name | Enas Khanneh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487078655 PECOS PAC ID: 6406178474 Enrollment ID: I20170829000151 |
| Provider Name | Ronda Mahmoud |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982248894 PECOS PAC ID: 8921422015 Enrollment ID: I20200722001682 |
| Provider Name | Jennifer Desch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912611898 PECOS PAC ID: 5395188338 Enrollment ID: I20240207001437 |
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