| Ennoble HC NJ II PC | |
|
2 University Plz Ste 204 Hackensack NJ 07601-6211 | |
| (551) 295-8223 | |
| Not Available |
| Full Name | Ennoble HC NJ II PC |
|---|---|
| Speciality | Family Medicine |
| Location | 2 University Plz Ste 204, Hackensack, New Jersey |
| Authorized Official Name and Position | Mark Bradshaw (OWNER) |
| Authorized Official Contact | 6786652618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice 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 Number | 1871475806 |
|---|---|
| Provider Enumeration Date | 07/22/2025 |
| Last Update Date | 08/29/2025 |
| Certification Date | 08/29/2025 |
| Medicare PECOS PAC ID | 9638672819 |
|---|---|
| Medicare Enrollment ID | O20250912002050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871475806 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | () | Primary |
| Provider Name | Ian Thompson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184606873 PECOS PAC ID: 6103907886 Enrollment ID: I20100120000744 |
| Provider Name | Molly Ann Mayfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407106727 PECOS PAC ID: 3274778410 Enrollment ID: I20130318000386 |
| Provider Name | Jason a Clemons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548678139 PECOS PAC ID: 6901115922 Enrollment ID: I20151014000921 |
| Provider Name | Jacinda Leadford |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730545922 PECOS PAC ID: 2567765464 Enrollment ID: I20160127001631 |
| Provider Name | Tina Joy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467812156 PECOS PAC ID: 4789981234 Enrollment ID: I20160328001665 |
| Provider Name | Brooke a Henderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184077273 PECOS PAC ID: 8325332406 Enrollment ID: I20160812000299 |
| Provider Name | Rhonda R Hilger |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558839472 PECOS PAC ID: 5597001990 Enrollment ID: I20190107000171 |
| Provider Name | Kelly Marlene Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700345345 PECOS PAC ID: 6103159520 Enrollment ID: I20190617002719 |
| Provider Name | Lavon L. Klahr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790249688 PECOS PAC ID: 8325373954 Enrollment ID: I20190718000729 |
| Provider Name | Wendy K Wilbur |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437648201 PECOS PAC ID: 5193053114 Enrollment ID: I20190828002464 |
| Provider Name | Alisa Valereyvna Tarasova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043782634 PECOS PAC ID: 0446683544 Enrollment ID: I20191203002933 |
| Provider Name | Stanley Eugene Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780141747 PECOS PAC ID: 6204262249 Enrollment ID: I20200211000525 |
| Provider Name | Theleka Tyne Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063882140 PECOS PAC ID: 7517396963 Enrollment ID: I20200406001489 |
| Provider Name | Amelia B Tinnin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821751694 PECOS PAC ID: 2860889110 Enrollment ID: I20220505000470 |
| Provider Name | Manuel Brockman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588152607 PECOS PAC ID: 4284982893 Enrollment ID: I20221228000578 |
| Provider Name | Kristin Collins |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134575038 PECOS PAC ID: 6507152006 Enrollment ID: I20240519000051 |
| Provider Name | Yuko Tango |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801649470 PECOS PAC ID: 7113369935 Enrollment ID: I20240524001979 |
| Provider Name | Brandi Patrickson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124292800 PECOS PAC ID: 3476735309 Enrollment ID: I20250113002868 |
| Provider Name | Mark Bradshaw |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316107428 PECOS PAC ID: 6608049275 Enrollment ID: I20250312003711 |
| Provider Name | Kylee Mccollough |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962201715 PECOS PAC ID: 3971027665 Enrollment ID: I20250403001083 |
| Provider Name | Laura Jackson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962293969 PECOS PAC ID: 1052830924 Enrollment ID: I20250522003353 |
| Provider Name | Reanna Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619863545 PECOS PAC ID: 1456850874 Enrollment ID: I20250814001250 |
| Provider Name | Courtney Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134954803 PECOS PAC ID: 7214288612 Enrollment ID: I20251007002468 |
| Provider Name | Lael Little |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730494980 PECOS PAC ID: 1759560279 Enrollment ID: I20251223004678 |
| Provider Name | Lauren Faith Neisent |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578437976 PECOS PAC ID: 0143716571 Enrollment ID: I20260106000609 |
| Provider Name | Melissa Barkemeyer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518384858 PECOS PAC ID: 9032342019 Enrollment ID: I20260203000438 |
| Provider Name | Tracy Ann Newman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790293033 PECOS PAC ID: 2567724321 Enrollment ID: I20260302002059 |
| Provider Name | Randi Chantel Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073463485 PECOS PAC ID: 9931682564 Enrollment ID: I20260312000603 |
| Provider Name | Angela Garner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952366692 PECOS PAC ID: 9436195906 Enrollment ID: I20260505004337 |
| Provider Name | Amber Nicole Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144705849 PECOS PAC ID: 2264770106 Enrollment ID: I20260624001293 |
Hackensack Digestive Disease Associates, P.A. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 52 1st St, Hackensack, NJ 07601 Phone: 201-488-3003 Fax: 201-488-6911 |
893 Medical LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5 Summit Ave Ste 106, Hackensack, NJ 07601 Phone: 201-212-5733 |
Ennoble HC NJ III PC Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2 University Plz Ste 204, Hackensack, NJ 07601 Phone: 551-295-8223 |
Mms Healthcare Management LLC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 241 Main St Fl 4, Hackensack, NJ 07601 Phone: 201-996-9035 |
Progressive Medical Services PC Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 560 Hudson St Ste 301, Hackensack, NJ 07601 Phone: 201-641-2125 Fax: 212-888-6024 |
Usk Management Corporation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 150 River St Apt 252, Hackensack, NJ 07601 Phone: 732-523-4057 |