Ennoble HC NJ II PC - Medicare Primary Care in Hackensack, NJ

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Ennoble HC NJ II PC is a medicare enrolled primary clinic (Family Medicine - Geriatric Medicine) in Hackensack, New Jersey. The current practice location for Ennoble HC NJ II PC is 2 University Plz Ste 204, Hackensack, New Jersey. For appointments, you can reach them via phone at (551) 295-8223. The mailing address for Ennoble HC NJ II PC is 2 University Plz Ste 204, Hackensack, New Jersey and phone number is (551) 295-8223.

Ennoble HC NJ II PC is licensed to practice in (license number ). The clinic also participates in the medicare program and its NPI number is 1871475806. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (551) 295-8223.

Contact Information

Ennoble HC NJ II PC
2 University Plz Ste 204
Hackensack
NJ 07601-6211
(551) 295-8223
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameEnnoble HC NJ II PC
SpecialityFamily Medicine
Location2 University Plz Ste 204, Hackensack, New Jersey
Authorized Official Name and PositionMark Bradshaw (OWNER)
Authorized Official Contact6786652618
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Ennoble HC NJ II PC
2 University Plz Ste 204
Hackensack
NJ 07601-6211

Ph: (551) 295-8223		Ennoble HC NJ II PC
2 University Plz Ste 204
Hackensack
NJ 07601-6211

Ph: (551) 295-8223

NPI Details:

NPI Number1871475806
Provider Enumeration Date07/22/2025
Last Update Date08/29/2025
Certification Date08/29/2025

Medicare PECOS Information:

Medicare PECOS PAC ID9638672819
Medicare Enrollment IDO20250912002050

Medical Identifiers

Medical identifiers for Ennoble HC NJ II PC such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1871475806NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207QG0300XFamily Medicine - Geriatric Medicine ()Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Ennoble HC NJ II PC acts as a billing entity for following providers:
Provider NameIan Thompson
Provider TypePractitioner - Family Practice
Provider IdentifiersNPI Number: 1184606873
PECOS PAC ID: 6103907886
Enrollment ID: I20100120000744
Provider NameMolly Ann Mayfield
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1407106727
PECOS PAC ID: 3274778410
Enrollment ID: I20130318000386
Provider NameJason a Clemons
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1548678139
PECOS PAC ID: 6901115922
Enrollment ID: I20151014000921
Provider NameJacinda Leadford
Provider TypePractitioner - Emergency Medicine
Provider IdentifiersNPI Number: 1730545922
PECOS PAC ID: 2567765464
Enrollment ID: I20160127001631
Provider NameTina Joy
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1467812156
PECOS PAC ID: 4789981234
Enrollment ID: I20160328001665
Provider NameBrooke a Henderson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1184077273
PECOS PAC ID: 8325332406
Enrollment ID: I20160812000299
Provider NameRhonda R Hilger
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1558839472
PECOS PAC ID: 5597001990
Enrollment ID: I20190107000171
Provider NameKelly Marlene Johnson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1700345345
PECOS PAC ID: 6103159520
Enrollment ID: I20190617002719
Provider NameLavon L. Klahr
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1790249688
PECOS PAC ID: 8325373954
Enrollment ID: I20190718000729
Provider NameWendy K Wilbur
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1437648201
PECOS PAC ID: 5193053114
Enrollment ID: I20190828002464
Provider NameAlisa Valereyvna Tarasova
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1043782634
PECOS PAC ID: 0446683544
Enrollment ID: I20191203002933
Provider NameStanley Eugene Smith
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1780141747
PECOS PAC ID: 6204262249
Enrollment ID: I20200211000525
Provider NameTheleka Tyne Williams
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1063882140
PECOS PAC ID: 7517396963
Enrollment ID: I20200406001489
Provider NameAmelia B Tinnin
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1821751694
PECOS PAC ID: 2860889110
Enrollment ID: I20220505000470
Provider NameManuel Brockman
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1588152607
PECOS PAC ID: 4284982893
Enrollment ID: I20221228000578
Provider NameKristin Collins
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1134575038
PECOS PAC ID: 6507152006
Enrollment ID: I20240519000051
Provider NameYuko Tango
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1801649470
PECOS PAC ID: 7113369935
Enrollment ID: I20240524001979
Provider NameBrandi Patrickson
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1124292800
PECOS PAC ID: 3476735309
Enrollment ID: I20250113002868
Provider NameMark Bradshaw
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1316107428
PECOS PAC ID: 6608049275
Enrollment ID: I20250312003711
Provider NameKylee Mccollough
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1962201715
PECOS PAC ID: 3971027665
Enrollment ID: I20250403001083
Provider NameLaura Jackson
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1962293969
PECOS PAC ID: 1052830924
Enrollment ID: I20250522003353
Provider NameReanna Harris
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1619863545
PECOS PAC ID: 1456850874
Enrollment ID: I20250814001250
Provider NameCourtney Davis
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1134954803
PECOS PAC ID: 7214288612
Enrollment ID: I20251007002468
Provider NameLael Little
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1730494980
PECOS PAC ID: 1759560279
Enrollment ID: I20251223004678
Provider NameLauren Faith Neisent
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1578437976
PECOS PAC ID: 0143716571
Enrollment ID: I20260106000609
Provider NameMelissa Barkemeyer
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1518384858
PECOS PAC ID: 9032342019
Enrollment ID: I20260203000438
Provider NameTracy Ann Newman
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1790293033
PECOS PAC ID: 2567724321
Enrollment ID: I20260302002059
Provider NameRandi Chantel Martin
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1073463485
PECOS PAC ID: 9931682564
Enrollment ID: I20260312000603
Provider NameAngela Garner
Provider TypePractitioner - Internal Medicine
Provider IdentifiersNPI Number: 1952366692
PECOS PAC ID: 9436195906
Enrollment ID: I20260505004337
Provider NameAmber Nicole Ellis
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1144705849
PECOS PAC ID: 2264770106
Enrollment ID: I20260624001293

Reviews and Comments

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.