Healthcare Provider Details

I. General information

NPI: 1336538305
Provider Name (Legal Business Name): CONSOLIDATED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROAD ST
BLOOMFIELD NJ
07003-2807
US

IV. Provider business mailing address

1000 BROAD ST
BLOOMFIELD NJ
07003-2807
US

V. Phone/Fax

Practice location:
  • Phone: 862-246-7899
  • Fax: 862-234-2006
Mailing address:
  • Phone: 862-246-7899
  • Fax: 862-234-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA03964100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number26NJ00186400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number26NJ00186400
License Number StateNJ

VIII. Authorized Official

Name: EBERE DIRIBE
Title or Position: APN
Credential:
Phone: 973-735-8531