Organization
CONSOLIDATED CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBERE DIRIBE (APN)
(973) 735-8531
Entity
Organization
Contact information
Practice address
410 CHANCELLOR AVE, NEWARK, NJ 07112-1030
(862) 246-7899
Mailing address
410 CHANCELLOR AVE, NEWARK, NJ 07112-1030
(862) 246-7899
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
25MA03964100
NJ
261QP2300X
Primary Care Clinic/Center
Primary
26NJ00186400
NJ
261QP3300X
Pain Clinic/Center
26NJ00186400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0424048
MEDICARE
NJ
Enumeration date
01/14/2015
Last updated
07/13/2016
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