Organization
IMMEDIATE CARE MEDICAL WALK-IN OF HAZLET, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M GOLDING-GRANADO MD (OWNER)
(732) 264-5500
Entity
Organization
Contact information
Practice address
1376 HIGHWAY 36, HAZLET, NJ 07730
(732) 264-5500
(732) 264-5554
Mailing address
1376 HIGHWAY 36, HAZLET, NJ 07730
(732) 264-5500
(732) 264-5554
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
HORIZON BLUE CROSS AND BLUE SHIELD
NJ
Enumeration date
07/05/2012
Last updated
01/17/2013
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