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General NPI Number Information
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NPI Number | 1295056604
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Entity Type | Organization
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Legal Business Name | IMMEDIATE MEDICAL SERVICE
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Dates
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Enumeration Date | 06/21/2010
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 240 MONMOUTH ROAD
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City | OAKHURST
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State | NJ
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Zip | 07755
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Country | US
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Telephone | 732-531-7711
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Fax | 732-531-3669
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Provider Business Mailing Address
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Address Line | 240 MONMOUTH ROAD
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City | OAKHURST
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State | NJ
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Zip | 07755
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Country | US
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Telephone | 732-531-7711
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Fax | 732-531-3669
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Authorized Official
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Title or Position | OWNER
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Name | JAY V WORTZEL
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Credential | MD
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Telephone | 732-531-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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