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General NPI Number Information
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NPI Number | 1215683842
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Entity Type | Organization
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Legal Business Name | INNOVATIVE MEDICAL PARTNERS
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Dates
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Enumeration Date | 02/22/2022
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Last Update Date | 02/22/2022
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Provider Practice Location Address
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Address Line | 701 UPPER BLVD
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-1124
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Country | US
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Telephone | 215-817-1799
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Fax |
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Provider Business Mailing Address
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Address Line | 30 N FRANKLIN TPKE PO BOX # 3
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City | HOHOKUS
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State | NJ
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Zip | 07423-9998
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Country | US
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Telephone | 215-817-1799
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN F MANGONE
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Credential | DO
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Telephone | 215-817-1799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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