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General NPI Number Information
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NPI Number | 1811245913
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF TOTOWA LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 426 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2562
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Country | US
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Telephone | 973-595-8400
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Fax | 973-595-8501
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Provider Business Mailing Address
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Address Line | 426 UNION BLVD
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City | TOTOWA
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State | NJ
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Zip | 07512-2562
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Country | US
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Telephone | 973-595-8400
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Fax | 973-595-8501
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARZENA ODORCZUK
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Credential | MD
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Telephone | 973-595-8400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA06967300
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License Number State | NJ
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