| Wellcare Tccm | |
|
250 Moore St Hackensack NJ 07601-7506 | |
| (201) 686-8734 | |
| Not Available |
| Full Name | Wellcare Tccm |
|---|---|
| Speciality | Internal Medicine |
| Location | 250 Moore St, Hackensack, New Jersey |
| Authorized Official Name and Position | Kaitlyn Gomez (OWNER) |
| Authorized Official Contact | 2016868734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wellcare Tccm 250 Moore St Hackensack NJ 07601-7506 Ph: (201) 686-8734 | Wellcare Tccm 250 Moore St Hackensack NJ 07601-7506 Ph: (201) 686-8734 |
| NPI Number | 1982245932 |
|---|---|
| Provider Enumeration Date | 10/01/2019 |
| Last Update Date | 10/22/2019 |
| Medicare PECOS PAC ID | 0648604199 |
|---|---|
| Medicare Enrollment ID | O20191217000504 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982245932 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Hammad M Rizvi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659516227 PECOS PAC ID: 9739376633 Enrollment ID: I20130312000015 |
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