| Clover Home Care | |
|
125 Chubb Ave Suite 100-s Lyndhurst NJ 07071-3504 | |
| (201) 559-7600 | |
| Not Available |
| Full Name | Clover Home Care |
|---|---|
| Speciality | Internal Medicine |
| Location | 125 Chubb Ave, Lyndhurst, New Jersey |
| Authorized Official Name and Position | Kelly Fontana (DIRECTOR OF CLINICAL COMPLIANCE) |
| Authorized Official Contact | 6314579145 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Clover Home Care 125 Chubb Ave Ste 100s Lyndhurst NJ 07071-3504 Ph: () - | Clover Home Care 125 Chubb Ave Suite 100-s Lyndhurst NJ 07071-3504 Ph: (201) 559-7600 |
| NPI Number | 1972044923 |
|---|---|
| Provider Enumeration Date | 03/10/2017 |
| Last Update Date | 10/12/2022 |
| Medicare PECOS PAC ID | 9931473139 |
|---|---|
| Medicare Enrollment ID | O20170927002286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972044923 | NPI | - | NPPES |
| Provider Name | Gwen Dodd Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427343482 PECOS PAC ID: 3072786862 Enrollment ID: I20111021000288 |
| Provider Name | Natasha N Ashton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427491703 PECOS PAC ID: 2567789936 Enrollment ID: I20150324000164 |
| Provider Name | Jessica Ji-won Son |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275851834 PECOS PAC ID: 2264729292 Enrollment ID: I20160920000227 |
| Provider Name | Kumar Dharmarajan |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1083741441 PECOS PAC ID: 6709002652 Enrollment ID: I20191226000073 |
| Provider Name | Gonzalo Olivares Maldonado |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326300807 PECOS PAC ID: 1052606233 Enrollment ID: I20230808001986 |
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