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General NPI Number Information
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NPI Number | 1578728481
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Entity Type | Organization
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Legal Business Name | NEW IMAGE MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 07/21/2008
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Last Update Date | 09/27/2011
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Provider Practice Location Address
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Address Line | 103 PARKER RD SUITE B
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1009
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Country | US
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Telephone | 732-923-1777
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Fax | 732-923-1772
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Provider Business Mailing Address
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Address Line | 103 PARKER RD SUITE B
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1009
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Country | US
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Telephone | 732-923-1777
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Fax | 732-923-1772
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. ZORICA JELISIJEVIC MERCADANTE
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Credential | MD
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Telephone | 732-923-1777
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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 | MA68083
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License Number State | NJ
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