| Longevity Clinical Ltc Associates Of New Jersey | |
|
527 River Ave Lakewood NJ 08701-4722 | |
| (732) 905-0700 | |
| Not Available |
| Full Name | Longevity Clinical Ltc Associates Of New Jersey |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 527 River Ave, Lakewood, New Jersey |
| Authorized Official Name and Position | Diane Vincur (CLINICAL SUPPORT TALENT SPECIALIST) |
| Authorized Official Contact | 5618152427 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Longevity Clinical Ltc Associates Of New Jersey 11770 Us Highway 1 Ste 102e Palm Beach Gardens FL 33408-3052 Ph: () - | Longevity Clinical Ltc Associates Of New Jersey 527 River Ave Lakewood NJ 08701-4722 Ph: (732) 905-0700 |
| NPI Number | 1376114322 |
|---|---|
| Provider Enumeration Date | 07/09/2021 |
| Last Update Date | 07/09/2021 |
| Medicare PECOS PAC ID | 8820496540 |
|---|---|
| Medicare Enrollment ID | O20211012000002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376114322 | NPI | - | NPPES |
| Provider Name | Vicky M Mckeown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598879249 PECOS PAC ID: 4789760885 Enrollment ID: I20080331000187 |
| Provider Name | Barbara L Francesco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013008846 PECOS PAC ID: 8325117914 Enrollment ID: I20080522000217 |
| Provider Name | Rustica D Atienza |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538411830 PECOS PAC ID: 1759532658 Enrollment ID: I20121126000503 |
| Provider Name | Sherene T Dunkley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013266709 PECOS PAC ID: 7911143292 Enrollment ID: I20130410000470 |
| Provider Name | Regina B Glisson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245576834 PECOS PAC ID: 7214175256 Enrollment ID: I20130603000206 |
| Provider Name | Jiao Li |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750625208 PECOS PAC ID: 3971742057 Enrollment ID: I20130621000068 |
| Provider Name | Teresa Louise Conner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629481528 PECOS PAC ID: 5395963243 Enrollment ID: I20140905001945 |
| Provider Name | Aryay Gefen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962884791 PECOS PAC ID: 0840504262 Enrollment ID: I20160106001299 |
| Provider Name | Courtney Lauren Berhang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306204458 PECOS PAC ID: 9335431519 Enrollment ID: I20160708000235 |
| Provider Name | Susan L Ezzi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730547480 PECOS PAC ID: 3971883471 Enrollment ID: I20161129000456 |
| Provider Name | Georgiette Ameyaw-wordie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245680800 PECOS PAC ID: 1254608896 Enrollment ID: I20170601001873 |
| Provider Name | Diana V Araque |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518493642 PECOS PAC ID: 0446522171 Enrollment ID: I20170816000040 |
| Provider Name | Olanda Dreher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144530361 PECOS PAC ID: 5496014888 Enrollment ID: I20180110000914 |
| Provider Name | Susan Heather Lake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790255941 PECOS PAC ID: 4082953294 Enrollment ID: I20190306001848 |
| Provider Name | Orabell Burgess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871040600 PECOS PAC ID: 1052695632 Enrollment ID: I20190619001093 |
| Provider Name | Donna Marie Wilson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730743741 PECOS PAC ID: 5092041616 Enrollment ID: I20190719000879 |
| Provider Name | Caroline Oloo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962063651 PECOS PAC ID: 4183954969 Enrollment ID: I20190920000445 |
| Provider Name | Cheryl Ann Gow |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699361840 PECOS PAC ID: 0547677718 Enrollment ID: I20210406001212 |
| Provider Name | Cristine Anette Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104578905 PECOS PAC ID: 4880621119 Enrollment ID: I20220223000811 |
| Provider Name | Ahone Ngalame |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548562200 PECOS PAC ID: 9133430630 Enrollment ID: I20221005000310 |
| Provider Name | Sookhee Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093100539 PECOS PAC ID: 8224497680 Enrollment ID: I20230703000035 |
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