Organization
JOSEPH R. IVAN, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH ROBERT IVAN M.D. (MANAGING MEMBER)
(732) 271-1771
Entity
Organization
Contact information
Practice address
110 REHILL AVE, SOMERVILLE, NJ 08876-2519
(908) 429-5817
Mailing address
1982 WASHINGTON VALLEY RD, PO BOX 309, MARTINSVILLE, NJ 08836-2043
(732) 271-1771
(732) 271-9477
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
25MA05501700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041633
MEDICARE GROUP
NJ
01
—
136194PCM
MEDICARE INDIVIDUAL
NJ
Enumeration date
12/28/2007
Last updated
12/28/2007
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