Ennoble Hc Nj III PC
NPI 1043192099 · Geriatric Medicine (Family Medicine) Physician · Hackensack, NJ
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1043192099
- Entity type
- Organization
- Primary specialty
- Geriatric Medicine (Family Medicine) PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Mark Bradshaw, Owner(678) 665-2618
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
Under 1 yr in registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
6 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Additional practice locations (5)
- 1000 Haddonfield Berlin Rd Ste 205Voorhees, NJ 08043-3520Phone: (973) 241-1356
- 3209 S Broadway Ste 229Edmond, OK 73013-4064Phone: (551) 295-8223
- 101 W Hefner RdOklahoma City, OK 73114-6631Phone: (405) 896-8058
- 101 Greenwood Ave Ste 140Jenkintown, PA 19046-2627Phone: (973) 241-1356
- 325 Chestnut St Ste 800Philadelphia, PA 19106-2608Phone: (973) 241-1356
Registry dates
- Enumerated
- 2025-07-22
- Last updated
- 2025-08-29
- Certified
- 2025-08-29
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.