Organization
ISLAND MEDICAL ASSOCIATES,PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER O KUPONIYI MD (INTERNAL MEDICINE)
(609) 568-5000
Entity
Organization
Contact information
Practice address
2626 TILTON RD, EGG HARBOR TWP, NJ 08234-1829
(609) 568-5000
(609) 568-5015
Mailing address
2626 TILTON RD, EGG HARBOR TWP, NJ 08234-1829
(609) 568-5000
(609) 568-5015
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
25MA05948800
NJ
2080A0000X
Pediatric Adolescent Medicine Physician
25MA04695100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0042102
—
NJ
Enumeration date
08/13/2006
Last updated
03/08/2011
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