Provider Demographics
NPI:1336538305
Name:CONSOLIDATED CARE LLC
Entity Type:Organization
Organization Name:CONSOLIDATED CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN
Authorized Official - Prefix:
Authorized Official - First Name:EBERE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-735-8531
Mailing Address - Street 1:410 CHANCELLOR AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1030
Mailing Address - Country:US
Mailing Address - Phone:862-246-7899
Mailing Address - Fax:
Practice Address - Street 1:410 CHANCELLOR AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-1030
Practice Address - Country:US
Practice Address - Phone:862-246-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03964100208D00000X
NJ26NJ00186400261QP2300X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0424048OtherMEDICARE