MEDICARE: INTEGRATED MEDICAL ASSOCIATES

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
1	174400000X	Specialist	25MB04647400	NJ

General Provider Information

NPI Number	:	1962627059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	687 ATLANTIC CITY BLVD
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2539
Country	:	US
Telephone Number	:	732-237-2200
Fax Number	:	732-606-9264

Provider Business Practice Location Address
First Line	:	687 ATLANTIC CITY BLVD
Second Line	:
City	:	BAYVILLE
State	:	NJ
Zip	:	08721-2539
Country	:	US
Telephone Number	:	732-237-2200
Fax Number	:	732-606-9264

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICHARD BART MENASHE
Credential	:	DO
Telephone Number	:	732-237-2200

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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