| Somc Medical Group Pc | |
|
2290 W County Line Rd Jackson NJ 08527-2267 | |
| (732) 364-3881 | |
| Not Available |
| Full Name | Somc Medical Group Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2290 W County Line Rd, Jackson, New Jersey |
| Authorized Official Name and Position | Carl Marchetti (PRESIDENT) |
| Authorized Official Contact | 7326434312 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Somc Medical Group Pc 1200 Jumping Brook Rd Building 5 Neptune NJ 07753-2634 Ph: (732) 643-4321 | Somc Medical Group Pc 2290 W County Line Rd Jackson NJ 08527-2267 Ph: (732) 364-3881 |
| NPI Number | 1699004606 |
|---|---|
| Provider Enumeration Date | 12/22/2009 |
| Last Update Date | 07/16/2014 |
| Medicare PECOS PAC ID | 4587799358 |
|---|---|
| Medicare Enrollment ID | O20100318000313 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699004606 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (New Jersey) | Primary |
| 213ES0103X | Podiatrist - Foot & Ankle Surgery | (New Jersey) | Secondary |
| Provider Name | Jay A Vida |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1831195601 PECOS PAC ID: 4981697117 Enrollment ID: I20040405001522 |
| Provider Name | Arthur H Braunwell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821094640 PECOS PAC ID: 4486633328 Enrollment ID: I20040715000368 |
| Provider Name | Rosalia C Riguerra |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891886008 PECOS PAC ID: 0941259634 Enrollment ID: I20050120000216 |
| Provider Name | Susan A Rivas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801928510 PECOS PAC ID: 6002869179 Enrollment ID: I20050301000470 |
| Provider Name | Nicholas D Cariddo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851455257 PECOS PAC ID: 9537246509 Enrollment ID: I20080402000570 |
| Provider Name | Mary C Okeefe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1467481846 PECOS PAC ID: 9436203718 Enrollment ID: I20090820000788 |
| Provider Name | Michael Rothberg |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1861498628 PECOS PAC ID: 2860407756 Enrollment ID: I20100212000296 |
| Provider Name | Anna Dedona |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194721902 PECOS PAC ID: 6507900065 Enrollment ID: I20100222000400 |
| Provider Name | Frederick Rothberg |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1033115738 PECOS PAC ID: 5193850709 Enrollment ID: I20100322000698 |
| Provider Name | Wael Elsamman |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1831419126 PECOS PAC ID: 4183811409 Enrollment ID: I20110412000904 |
| Provider Name | Nawid E Najafi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326258732 PECOS PAC ID: 0042356750 Enrollment ID: I20110913000093 |
| Provider Name | David E Konigsberg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114178142 PECOS PAC ID: 5395975072 Enrollment ID: I20140225000359 |
| Provider Name | Caitlyn Krichman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225446214 PECOS PAC ID: 7618198797 Enrollment ID: I20141015001490 |
| Provider Name | Mark Anthony Castillo Navarro |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1568774651 PECOS PAC ID: 8123253713 Enrollment ID: I20160205000193 |
| Provider Name | Diana L Fibison |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932479706 PECOS PAC ID: 0143525881 Enrollment ID: I20160218000527 |
| Provider Name | Elizabeth Ann Noller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154878296 PECOS PAC ID: 6608158548 Enrollment ID: I20170130000159 |
| Provider Name | Christopher W. Zukowski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407826746 PECOS PAC ID: 1951599323 Enrollment ID: I20171120000046 |
| Provider Name | Stephanie Ann Papa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710536842 PECOS PAC ID: 0648602227 Enrollment ID: I20191120001334 |
| Provider Name | Christina E Sawires |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1487182911 PECOS PAC ID: 0941629877 Enrollment ID: I20200928000040 |
| Provider Name | Justin Anthony Herrel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922537919 PECOS PAC ID: 0244646586 Enrollment ID: I20210310002222 |
| Provider Name | Lindsey Peragallo-flynn |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1326543091 PECOS PAC ID: 1254686116 Enrollment ID: I20211118001096 |
| Provider Name | Nicole G Babushkin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912495284 PECOS PAC ID: 0345634655 Enrollment ID: I20220303000301 |
| Provider Name | Ashley Aya |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295298594 PECOS PAC ID: 3577938091 Enrollment ID: I20230413002193 |
| Provider Name | Amanda Dawson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134681455 PECOS PAC ID: 6901262419 Enrollment ID: I20230524003874 |
| Provider Name | Giuseppe Filice |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164983383 PECOS PAC ID: 0941667489 Enrollment ID: I20230527000007 |
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