Unknown Individual – Internal Medicine Physician, NPI 1073523627

Unknown Individual is a healthcare provider. based in Elizabeth, New Jersey. specializing in Internal Medicine Physician. They hold a License No. MAO46519 (NJ). The NPI Number for Unknown Individual is 1073523627

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073523627
Phone
(908) 352-4477
Address
216 PALMER ST
Deactivation Date
1 December 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7324491352
Graduation Year
1983 (43 years ago)
PAC ID
3173510377
Group Practice PAC ID
6103076526
Professional Enrollment ID
I20040429000217
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 216, Palmer Street, Union Square, Elizabeth, Union County, New Jersey, 07202, United States

    ELIZABETH, NJ 072023918

    Phone: (908) 352-4477

    Fax: (908) 355-1202

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 07202)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6103076526View full group profile

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1073523627 uniquely identifies Unknown Individual in U.S. healthcare data.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
Can patients visit Unknown Individual in Elizabeth, New Jersey?
For routing, start with Elizabeth, New Jersey for Unknown Individual, then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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Unknown Individual

Internal Medicine Physician
81 TIMBERHILL DR
NPI: 1649249459