=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528363371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTHRITIS INTERNAL MEDICINE ASSOCIATES OF MIDDLESEX
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2011
-----------------------------------------------------
Last Update Date | 01/25/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 63 BRUNSWICK WOODS DR
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-613-1900
-----------------------------------------------------
Fax | 732-613-0029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63 BRUNSWICK WOODS DR
-----------------------------------------------------
City | EAST BRUNSWICK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08816-5601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-613-1900
-----------------------------------------------------
Fax | 732-613-0029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. ALAN SHELDON LICHTBROUN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 732-613-1900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------