| North Jersey Internal Medicine Pc | |
|
92 Summit Ave Hackensack NJ 07601-1263 | |
| (201) 342-0066 | |
| (201) 342-0079 |
| Full Name | North Jersey Internal Medicine Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 92 Summit Ave, Hackensack, New Jersey |
| Authorized Official Name and Position | Ehab Ibrahim (OWNER) |
| Authorized Official Contact | 2013420066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Jersey Internal Medicine Pc 92 Summit Ave Hackensack NJ 07601-1263 Ph: (201) 342-0066 | North Jersey Internal Medicine Pc 92 Summit Ave Hackensack NJ 07601-1263 Ph: (201) 342-0066 |
| NPI Number | 1114027885 |
|---|---|
| Provider Enumeration Date | 09/23/2006 |
| Last Update Date | 02/20/2019 |
| Medicare PECOS PAC ID | 6103840731 |
|---|---|
| Medicare Enrollment ID | O20060125000758 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114027885 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MA07752000 (New Jersey) | Primary |
| Provider Name | Ehab F Ibrahim |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942395108 PECOS PAC ID: 2365408507 Enrollment ID: I20041208001032 |
| Provider Name | Marion Y Bobb-mckoy |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184709206 PECOS PAC ID: 8628167301 Enrollment ID: I20130610000243 |
| Provider Name | Veronica Roupenian |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518410349 PECOS PAC ID: 3476835877 Enrollment ID: I20170119001736 |
| Provider Name | Krysten Wondrack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508324575 PECOS PAC ID: 3173856168 Enrollment ID: I20190606000238 |
| Provider Name | Maria Esther Fuentes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497394605 PECOS PAC ID: 0941624381 Enrollment ID: I20200720000318 |
| Provider Name | Ewa M Slaby |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407420581 PECOS PAC ID: 9739582131 Enrollment ID: I20210722002255 |
| Provider Name | Kimberly J Perdomo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861068827 PECOS PAC ID: 2365846615 Enrollment ID: I20210809001033 |
| Provider Name | Lisa Marie Koumoulos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700482866 PECOS PAC ID: 9335545573 Enrollment ID: I20210914000017 |
| Provider Name | Lane R Kocovsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912579996 PECOS PAC ID: 3274930946 Enrollment ID: I20210922002206 |
| Provider Name | Cristina Zamora |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386313070 PECOS PAC ID: 4385042902 Enrollment ID: I20211013000811 |
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