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General NPI Number Information
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NPI Number | 1033477104
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Entity Type | Organization
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Legal Business Name | IRONBOUND FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 04/26/2012
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 154 VAN BUREN ST 1ST FLOOR
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City | NEWARK
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State | NJ
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Zip | 07105-2984
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Country | US
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Telephone | 973-344-6727
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Fax | 973-491-5033
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Provider Business Mailing Address
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Address Line | 154 VAN BUREN ST 1ST FLOOR
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City | NEWARK
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State | NJ
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Zip | 07105-2984
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Country | US
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Telephone | 973-344-6727
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Fax | 973-491-5033
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | ARLENE HALLEGADO
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Credential |
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Telephone | 973-344-6727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MA060257
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License Number State | NJ
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