Provider Demographics
NPI:1053662692
Name:PM&R FIRST MEDICAL P.C.
Entity Type:Organization
Organization Name:PM&R FIRST MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IOFFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-782-4290
Mailing Address - Street 1:PO BOX 11216
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08906-1216
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1187 MAIN AVE
Practice Address - Street 2:SUITE 1D
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2252
Practice Address - Country:US
Practice Address - Phone:347-782-4290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26MA09109300261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty