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General NPI Number Information
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NPI Number | 1508046616
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Entity Type | Organization
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Legal Business Name | IMMEDIATE CARE AND FAMILY MEDICAL CENTER LLC
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Dates
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Enumeration Date | 11/06/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 2640 HIGHWAY 70 BLDG 12, SUITE 102
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City | MANASQUAN
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State | NJ
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Zip | 08736-2609
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Country | US
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Telephone | 732-223-3533
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Fax | 732-223-3588
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Provider Business Mailing Address
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Address Line | 2640 HIGHWAY 70 BLDG 12, SUITE 102
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City | MANASQUAN
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State | NJ
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Zip | 08736-2609
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Country | US
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Telephone | 732-223-3533
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Fax | 732-223-3588
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Authorized Official
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Title or Position | OWNER
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Name | MS. JULIE JOHNSON
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Credential | MD
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Telephone | 732-223-3533
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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 |
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License Number State |
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