Kdl19 Llc is a medicare enrolled "Clinic/center - Multi-specialty" provider in Jersey City, New Jersey. Their current practice location is
1217 Summit Ave, Jersey City, New Jersey. You can reach out to their office (for appointments etc.) via phone at
(201) 984-0520.
Kdl19 Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Kdl19 Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1568204394.
Healthcare Provider's Profile
| Full Name | Kdl19 Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Multi-specialty |
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| Location | 1217 Summit Ave, Jersey City, New Jersey |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1568204394
- Provider Enumeration Date: 06/11/2024
- Last Update Date: 03/02/2025
Medicare PECOS Information:
- PECOS PAC ID: 2062949456
- Enrollment ID: O20241226000017
Medical Identifiers
Medical identifiers for Kdl19 Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1568204394 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 231H00000X | Audiologist | (* (Not Available)) | Secondary |
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Kdl19 Llc acts as a billing entity for following providers:
| Provider Name | Brian Christian Bourne |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1508943226
PECOS PAC ID: 2567799562
Enrollment ID: I20190814001744 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kdl19 Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kdl19 Llc
1217 Summit Ave,
Jersey City, NJ 07307-3138
Ph: () - | Kdl19 Llc
1217 Summit Ave,
Jersey City, NJ 07307-3138
Ph: (201) 984-0520 |
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