Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mobile Medicare

Organization Geriatric Medicine (Family Medicine) Physician · NPI 1457460594

Mobile Medicare is a Geriatric Medicine (Family Medicine) Physician in Clark, New Jersey. Licensed in New Jersey. Registered with an NPI since 2006.

Licensed in
NJ
In the registry since
2006
Specialties on file
3

Practice location Address checks out

67 Walnut Ave
Clark, NJ 07066-1640
Phone: (732) 388-7300
Fax: (732) 388-1330
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Family Medicine) Physician (primary) Taxonomy 207QG0300X · Licence MB27483 (NJ)
Geriatric Medicine (Family Medicine) Physician Taxonomy 207QG0300X · Licence MB53933 (NJ)
Internal Medicine Physician Taxonomy 207R00000X · Licence MB71509 (NJ)

Record details

NPI number1457460594
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Colleen Tiedemann — Office Manager · (732) 388-7300
NPI enumeratedAugust 30, 2006
Last updated in NPPESAugust 6, 2007
Mailing address67 Walnut Ave, Clark, NJ 07066-1640