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General NPI Number Information
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NPI Number | 1346725561
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Entity Type | Organization
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Legal Business Name | DEPTFORD INTERNAL MEDICINE ASSOCIATES LLC
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Dates
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Enumeration Date | 10/03/2018
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Last Update Date | 10/03/2018
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Provider Practice Location Address
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Address Line | 1132 COOPER STREET SUITE THREE
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City | DEPTFORD
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State | NJ
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Zip | 08096-3014
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Country | US
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Telephone | 856-848-8060
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Fax | 856-848-8038
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | MICKLETON
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State | NJ
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Zip | 08056-0069
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Country | US
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Telephone | 856-848-8060
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Fax | 856-848-8038
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Authorized Official
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Title or Position | OWNER
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Name | IMRAN AZAM MIRZA
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Credential | MD
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Telephone | 732-743-5910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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