MEDICARE: ADVANCED INTERNAL MEDICINE PA

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1124375290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED INTERNAL MEDICINE PA

Provider Business Mailing Address
First Line	:	1015 NEW RD
Second Line	:	SUITE C
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1600
Country	:	US
Telephone Number	:	609-677-0700
Fax Number	:	609-677-9060

Provider Business Practice Location Address
First Line	:	1015 NEW RD
Second Line	:	SUITE C
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-1600
Country	:	US
Telephone Number	:	609-677-0700
Fax Number	:	609-677-9060

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN NACHTIGALL
Credential	:	MD
Telephone Number	:	609-677-0700

Provider Enumeration Date	:	08/08/2012
Last Update Date	:	08/08/2012

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