Unknown Individual – Family Medicine Physician, NPI 1306874490

Family Medicine Physician

Unknown Individual is a healthcare provider. based in Bloomfield, New Jersey. specializing in Family Medicine Physician. They hold a License No. 20175 (NJ). The NPI Number for Unknown Individual is 1306874490

Main info

Organization

Inactive

67 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1306874490

Phone

(973) 743-2331

Address

PO BOX 1939

Deactivation Date

22 December 2020

Doctor Profile

Medical School Name

OTHER

Secondary Phone

9736674402

Graduation Year

1959 (67 years ago)

PAC ID

5193861003

Group Practice PAC ID

9537292792

Professional Enrollment ID

I20091007000304

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

Bloomfield Post Office, 323, Beersbridge Road, Sydenham, Bloomfield, Belfast, Belfast City District, County Down, Northern Ireland, BT5 5DY, United Kingdom
BLOOMFIELD, NJ 070031939
Phone: (973) 743-2331
Fax: (973) 743-1441
Type: Mailing
187, Chestnut Street, Avondale, Nutley, Essex County, New Jersey, 07110, United States
NUTLEY, NJ 071102311
Phone: (973) 667-4402
Fax: (973) 667-6974
Type: Location

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 07003)

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Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1306874490 for Unknown Individual, then check state licensing separately.

Why is Unknown Individual marked inactive in the NPI directory?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What healthcare role does Unknown Individual hold?

Scheduling teams often label Unknown Individual under Family Medicine Physician. Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is Bloomfield, New Jersey in our summary view.

Is the information about Unknown Individual up to date?

Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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