Provider Demographics
NPI:1467849364
Name:COMPREHENSIVE NEPHROLOGY OF NORTHERN NEW JERSEY LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE NEPHROLOGY OF NORTHERN NEW JERSEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:
Authorized Official - Last Name:IBEABUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-967-8425
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-0157
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:201-263-4665
Practice Address - Street 1:230 E RIDGEWOOD AVE
Practice Address - Street 2:BLDG. 6 2ND FLOOR
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-4142
Practice Address - Country:US
Practice Address - Phone:201-225-4700
Practice Address - Fax:201-225-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-20
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08621600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ220390Medicare PIN