SHAZAM BACCHUS (NPI# 1972133254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972133254 |
| Entity Type | Individual |
| Full Name | SHAZAM BACCHUS |
| Credential | APN |
| Practice Address |
459 N 7th St Fl 1 Newark NJ 07107-3743 |
| Practice Telephone | 9733889560 |
| Mailing Telephone | 9733889560 |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2020-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
26NJ01004000 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
459 N 7TH ST FL 1 |
| City | NEWARK |
| State | NJ |
| Zip Code | 07107-3743 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134747272 | Kobie Blair Morgan | Counselor | Kobie Blair Morgan, Esq., Mba, Ma, Lpc, 76-78 First Street, Suite 3, Newark, NJ 07107 | 2020-07-06 |
| 1811522634 | Yasheika Hermitt South | Licensed Practical Nurse | North 11th Street, Newark, NJ 07107 | 2020-03-12 |
| 1568941375 | Orange Street Spec LLC | Dentist | 509a Orange Street Suite A, Newark, NJ 07107 | 2018-08-13 |
| 1548617103 | Jose Andres Morales | Case Manager/Care Coordinator | 541 Roseville Av., Newark, NJ 07107 | 2016-05-24 |
| 1053743997 | Center for Wound Science and Healing | General Acute Care Hospital | 495 North 13th Street, 2nd Floor, Newark, NJ 07107 | 2013-08-02 |
| 1750620944 | Jeevan M Mathew | Physical Therapist | 500 0range Street, Suite 2, Newark, NJ 07107 | 2013-02-07 |
| 1982967386 | D & M Quality of Life Services, LLP | In Home Supportive Care | 285 Roseville Avenue, Suite 118, Newark, NJ 07107 | 2012-06-20 |
| 1710121496 | Paul Hsu | Pharmacist | 421 Bloomfield Ave, Guardys, Newark, NJ 07107 | 2009-04-27 |
| 1194969774 | Prescriptions Etc Inc. | Clinic/Center | 421 Bloomfield Ave., Guardys, Newark, NJ 07107 | 2009-04-27 |
| 1821269630 | Chandra Gupta | Pediatrics | 156 Roseville Avenue, Newark, NJ 07107 | 2008-03-19 |
| Find all providers in zip 07107 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619271962 | Pamela N Poad | Nurse Practitioner | 2 Warner Ct, Newark, DE 19711-2346 | 2010-12-30 |
| 1538772165 | Monica Yvette Johnson | Nurse Practitioner | 741 Broadway, Newark, NJ 07104-4309 | 2020-08-24 |
| 1124650387 | Hyoeun Kim | Nurse Practitioner | 150 Bergen St, Newark, NJ 07103-2496 | 2020-02-06 |
| 1700431525 | Jacqueline Busch | Nurse Practitioner | 150 Bergen St, Newark, NJ 07103-2496 | 2019-08-08 |
| 1164994521 | Hannah Twumwaa | Nurse Practitioner | 201 Lyons Ave, Newark, NJ 07112-2027 | 2018-12-26 |
| 1942708698 | Tameka S Villa | Nurse Practitioner | 201 Lyons Ave, Newark, NJ 07112-2027 | 2018-01-29 |
| 1801337944 | Justin K. Wilson | Nurse Practitioner | 201 Lyons Ave, Newark, NJ 07112-2027 | 2017-03-08 |
| 1912265380 | Maura Ellen Hinckle | Nurse Practitioner | 1 Centurian Dr, Newark, DE 19713-2137 | 2012-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730780479 | Mae Lynne Tietje | Nurse Practitioner | 3830 Atlantic Ave, Atlantic City, NJ 08401-6080 | 2020-11-07 |
| 1710586987 | Rosemarie B Londono | Nurse Practitioner | 20 Prospect Ave Ste 600, Hackensack, NJ 07601-1962 | 2020-10-20 |
| 1063010940 | Shruti Satish Patel | Nurse Practitioner | 78 Diana Dr, South Plainfield, NJ 07080-4437 | 2020-10-13 |
| 1366049058 | Sedrina Taina Austin | Nurse Practitioner | 82 Poplar Ave, Hackensack, NJ 07601-4707 | 2020-10-06 |
| 1952912768 | Holly M Gonzalez | Nurse Practitioner | 240 Williamson St Ste 306, Elizabeth, NJ 07202-3672 | 2020-08-14 |
| 1073124327 | Queen K Aggrey | Nurse Practitioner | 1308 Wharton Rd, Mount Laurel, NJ 08054-5296 | 2020-08-11 |
| 1497365480 | Ann Margaret Prejs | Nurse Practitioner | 2401 Highway 35 Ste A, Manasquan, NJ 08736-1193 | 2020-08-04 |
| 1164046355 | Barbara Raymond | Nurse Practitioner | 776 Nixon Rd, Union, NJ 07083-7620 | 2020-06-03 |
| 1871112557 | Care First-choice | Nurse Practitioner | 302 Harrison Ave, Millville, NJ 08332-2408 | 2020-04-13 |
| 1568081461 | Melissa N Pagan | Nurse Practitioner | 128 Maple St, Jersey City, NJ 07304-3733 | 2020-04-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.