Organization
IMMEDICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAQUEL SMITH (OFFICE MANAGER)
(973) 643-8383
Entity
Organization
Contact information
Practice address
360 AVENUE P, 3RD FLOOR, NEWARK, NJ 07105-4802
(973) 928-8940
Mailing address
360 AVENUE P, 3RD FLOOR, NEWARK, NJ 07105-4802
(973) 928-8940
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
25MA6818400
NJ
Other
Enumeration date
05/10/2016
Last updated
05/10/2016
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