MEDICARE: ISLAND MEDICAL PROFESSIONAL ASSOCIATION

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265549539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND MEDICAL PROFESSIONAL ASSOCIATION

Provider Business Mailing Address
First Line	:	1812 LONG BEACH BLVD
Second Line	:
City	:	SHIP BOTTOM
State	:	NJ
Zip	:	08008-4443
Country	:	US
Telephone Number	:	609-494-2323
Fax Number	:	609-494-4141

Provider Business Practice Location Address
First Line	:	1812 LONG BEACH BLVD
Second Line	:
City	:	SHIP BOTTOM
State	:	NJ
Zip	:	08008-4443
Country	:	US
Telephone Number	:	609-494-2323
Fax Number	:	609-494-4141

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES NOLAND SUDDETH
Credential	:	M.D.
Telephone Number	:	609-494-2323

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/05/2011

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