Healthcare Provider Details

I. General information

NPI: 1679634307
Provider Name (Legal Business Name): IDEALMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WHITE RD SUITE 212
LITTLE SILVER NJ
07739-1150
US

IV. Provider business mailing address

200 WHITE RD SUITE 212
LITTLE SILVER NJ
07739-1150
US

V. Phone/Fax

Practice location:
  • Phone: 732-741-5600
  • Fax: 732-345-1001
Mailing address:
  • Phone: 732-741-5600
  • Fax: 732-345-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEERAJ MEHRA
Title or Position: MEMBER
Credential: M.D.
Phone: 732-741-5600