Organization
IMMEDICENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIA C SQUIRLOCK (ADMINISTRATOR)
(973) 778-5566
Entity
Organization
Contact information
Practice address
1355 BROAD ST, CLIFTON, NJ 07013-4221
(973) 778-5566
(973) 778-4044
Mailing address
1355 BROAD ST, CLIFTON, NJ 07013-4221
(973) 778-5566
(973) 778-4044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB7304
RAILROAD MEDICARE
NJ
Enumeration date
09/16/2006
Last updated
03/18/2009
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