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General NPI Number Information
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NPI Number | 1538419148
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Entity Type | Organization
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Legal Business Name | I.M.E.M. CLINICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 500 RIVER AVE STE 255
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4738
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Country | US
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Telephone | 917-734-3322
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Fax | 845-503-2152
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Provider Business Mailing Address
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Address Line | 500 RIVER AVE STE 255
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City | LAKEWOOD
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State | NJ
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Zip | 08701-4738
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Country | US
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Telephone | 417-353-9069
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Fax | 417-429-2893
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Authorized Official
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Title or Position | OWNER/PHYSICIAN/CEO
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Name | DR. HILLEL PELTZ
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Credential | MD
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Telephone | 417-353-9069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MB07628300
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License Number State | NJ
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