ENNOBLE HC NJ III PC – Geriatric Medicine (Family Medicine) Physician, NPI 1043192099
Geriatric Medicine (Family Medicine) Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ENNOBLE HC NJ III PC
101 Greenwood Ave Ste 140
Jenkintown, PA 190462627
Phone: (973) 241-1356
Type: Location
1000 Haddonfield Berlin Rd Ste 205
Voorhees, NJ 080433520
Phone: (973) 241-1356
Type: Location
325 Chestnut St Ste 800
Philadelphia, PA 191062608
Phone: (973) 241-1356
Type: Location
2 UNIVERSITY PLZ STE 204
HACKENSACK, NJ 076016211
Phone: (551) 295-8223
Type: Mailing
3209 S Broadway Ste 229
Edmond, OK 730134064
Phone: (551) 295-8223
Type: Location
101 W Hefner Rd
Oklahoma City, OK 731146631
Phone: (405) 896-8058
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-10-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20250911004607 | O | Clinic/Group Practice | NJ | TBD |
| O20250912001618 | O | Clinic/Group Practice | OK | TBD |
| O20251013003531 | O | Clinic/Group Practice | PA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
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 19046)
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