Unknown Individual – Clinical Social Worker, NPI 1508939380

Unknown Individual is a healthcare provider. based in Hackensack, New Jersey. specializing in Clinical Social Worker. They hold a License No. 37PC00045100 (NJ). The NPI Number for Unknown Individual is 1508939380

Main info

Organization
Inactive
27 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1508939380
Phone
(201) 488-6678
Address
83 SUMMIT AVENUE
Deactivation Date
4 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2017947733
Graduation Year
1999 (27 years ago)
PAC ID
3072872662
Group Practice PAC ID
9638485329
Professional Enrollment ID
I20180104000476
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

  • 83, Summit Avenue, Hackensack, Bergen County, New Jersey, 07601, United States

    HACKENSACK, NJ 07601

    Phone: (201) 488-6678

    Fax: (201) 224-0599

    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 07601)

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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: 9638485329View full group profile

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1508939380 when you need to reference Unknown Individual in forms, claims, or directories.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Clinical Social Worker. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Hackensack, New Jersey for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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