Organization
IMMEDICENTER BLOOMFIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA C SQUIRLOCK (ADMINISTRATOR)
(973) 778-5566
Entity
Organization
Contact information
Practice address
557 BROAD ST, BLOOMFIELD, NJ 07003-2885
(973) 680-8300
(973) 743-5601
Mailing address
557 BROAD ST, BLOOMFIELD, NJ 07003-2885
(973) 680-8300
(973) 743-5601
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB4172
RAILROAD MEDICARE
NJ
Enumeration date
09/16/2006
Last updated
03/18/2009
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