Healthcare Provider Details

I. General information

NPI: 1558850214
Provider Name (Legal Business Name): INLET MEDICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S RHODE ISLAND AVE
ATLANTIC CITY NJ
08401-7759
US

IV. Provider business mailing address

199 NEW RD STE 61-398
LINWOOD NJ
08221-2025
US

V. Phone/Fax

Practice location:
  • Phone: 609-559-0070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER KUPONIYI
Title or Position: OWNER
Credential:
Phone: 609-559-0070