MOBILE MEDICARE NPI 1457460594

NPI Information

  • NPI: 1457460594
  • Provider Name: MOBILE MEDICARE
  • Classification: Family Medicine - 207QG0300X
  • Specialization: Geriatric Medicine
  • Entity Type: Organization
  • Address: 67 WALNUT AVE
    CLARK, NJ
    ZIP 07066
  • Phone: (732) 388-7300

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NPI Details

MOBILE MEDICARE is a geriatric medicine family medicine in Clark, NJ. The provider is a family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital. MOBILE MEDICARE NPI is 1457460594. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

67 WALNUT AVE
CLARK, NJ
ZIP 07066-640
Phone: (732) 388-7300
Fax: (732) 388-1330

The provider's authorized official is Colleen Elizabeth Tiedemann .
The authorized official title is Office Manager and has the following contact phone number (732) 388-7300.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 8/6/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207QG0300XFamily MedicineGeriatric MedicineMB53933NEW JERSEYNo
2207R00000XInternal MedicineMB71509NEW JERSEYNo
3207QG0300XFamily MedicineGeriatric MedicineMB27483NEW JERSEYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1H51969MEDICARE UPINNEW JERSEY
2F12985MEDICARE UPINNEW JERSEY
3E06173MEDICARE UPINNEW JERSEY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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