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NPI Code Detail

MEDICARE: IMMEDICARE

MEDICARE: IMMEDICARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QH0100XHealth Service Clinic/Center25MA6818400NJ

General Provider Information

NPI Number : 1659727550
Entity Type Code : Organization
Provider Name (Legal Business Name) : IMMEDICARE
Provider Business Mailing Address
First Line : 360 AVENUE P
Second Line : 3RD FLOOR
City : NEWARK
State : NJ
Zip : 07105-4802
Country : US
Telephone Number : 973-928-8940
Fax Number :
Provider Business Practice Location Address
First Line : 360 AVENUE P
Second Line : 3RD FLOOR
City : NEWARK
State : NJ
Zip : 07105-4802
Country : US
Telephone Number : 973-928-8940
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : RAQUEL SMITH
Credential :
Telephone Number : 973-643-8383
Provider Enumeration Date : 05/10/2016
Last Update Date : 05/10/2016

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