Healthcare Provider Details

I. General information

NPI: 1265463624
Provider Name (Legal Business Name): INTEGRATED MEDICAL CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 MAIN ST
TOMS RIVER NJ
08753-6519
US

IV. Provider business mailing address

803 MAIN ST
TOMS RIVER NJ
08753-6519
US

V. Phone/Fax

Practice location:
  • Phone: 732-557-0100
  • Fax:
Mailing address:
  • Phone: 732-557-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number26NJ00017800
License Number StateNJ

VIII. Authorized Official

Name: MS. CARMEN PEREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-557-0100