Healthcare Provider Details

I. General information

NPI: 1174187728
Provider Name (Legal Business Name): SIGNIFY HEALTH MEDICAL ASSOCIATES OF NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 VILLAGE BLVD STE 200
PRINCETON NJ
08540-5700
US

IV. Provider business mailing address

4055 VALLEY VIEW LN STE 700
DALLAS TX
75244-5045
US

V. Phone/Fax

Practice location:
  • Phone: 877-868-5351
  • Fax:
Mailing address:
  • Phone: 972-715-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT SHAWN BRONKE
Title or Position: MANAGER, PROVIDER ENROLLMENT
Credential:
Phone: 694-909-6446