Organization
DEPTFORD INTERNAL MEDICINE ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMRAN AZAM MIRZA MD (OWNER)
(732) 743-5910
Entity
Organization
Contact information
Practice address
1132 COOPER STREET SUITE THREE, DEPTFORD, NJ 08096-3014
(856) 848-8060
(856) 848-8038
Mailing address
PO BOX 69, MICKLETON, NJ 08056-0069
(856) 848-8060
(856) 848-8038
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA08024700
STATE LICENSE
NJ
Enumeration date
10/03/2018
Last updated
10/03/2018
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