Ennoble Hc Ky II PLLC
Family Medicine, Geriatric Medicine in Hackensack, NJ. Organization (NPI-2).
NPI number1285560490
StatusActive
Last updated in NPPESJun 23, 2026
Details
- NPI
- 1285560490
- Entity type
- Organization (NPI-2)
- Legal business name
- Ennoble Hc Ky II PLLC
- Organization subpart
- No
- Enumeration date
- Jun 23, 2026
- Certification date
- Jun 24, 2026
- Last updated
- Jun 23, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART B SUPPLIER - CLINIC/GROUP PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QG0300X | Family Medicine, Geriatric Medicine | – | – | Yes |
Practice location
2 University PlzHackensack, NJ 07601-6202
Phone 551-295-8223
Mailing address
2 University PlzHackensack, NJ 07601-6202
Phone 551-295-8223
Authorized official
Mark Bradshaw
Owner
6786652618
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