MEDICARE: IMMEDICENTER BLOOMFIELD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB4172	OTHER	NJ	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1023114899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMMEDICENTER BLOOMFIELD

Provider Business Mailing Address
First Line	:	557 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2885
Country	:	US
Telephone Number	:	973-680-8300
Fax Number	:	973-743-5601

Provider Business Practice Location Address
First Line	:	557 BROAD ST
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-2885
Country	:	US
Telephone Number	:	973-680-8300
Fax Number	:	973-743-5601

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARIA C SQUIRLOCK
Credential	:
Telephone Number	:	973-778-5566

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	03/18/2009

Similar Medicare Providers

1578405395 — ASTIR PHYSICAL THERAPY AND WELLNESS LLC
Practice Location Address:

557 BROAD ST
BLOOMFIELD, NJ
07003-2885

Practice Phone: 973-404-1800
Practice Fax:

1891869483 — DR. PADMAVATHY ALLI D.O
Practice Location Address:

557 BROAD ST , SUITE 22
BLOOMFIELD, NJ
07003-2885

Practice Phone: 973-429-9844
Practice Fax: 973-429-9858

1316000540 — DR. PARUL S. AMIN M.D.
Practice Location Address:

557 BROAD ST , RM 22
BLOOMFIELD, NJ
07003-2885

Practice Phone: 973-667-6650
Practice Fax: 201-854-0050

1114062957 — MS. MICHELE WEISBERGER RD
Practice Location Address:

557 BROAD ST
BLOOMFIELD, NJ
07003-2885

Practice Phone: 973-680-8300
Practice Fax: 973-680-1770

1619191038 — MRS. ELIZABETH JANETTE VANDYK DNP, RN, FNP-C
Practice Location Address:

557 BROAD ST
BLOOMFIELD, NJ
07003-2885

Practice Phone: 973-680-8300
Practice Fax:

1861609786 — FREDA & SURIANO ORTHODONTICS
Practice Location Address:

557 BROAD ST
BLOOMFIELD, NJ
07003-2885

Practice Phone: 973-748-2248
Practice Fax: 973-748-7004

Directions to “IMMEDICENTER BLOOMFIELD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.