Provider Demographics
NPI:1124375290
Name:ADVANCED INTERNAL MEDICINE PA
Entity Type:Organization
Organization Name:ADVANCED INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHTIGALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-677-0700
Mailing Address - Street 1:1015 NEW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1600
Mailing Address - Country:US
Mailing Address - Phone:609-677-0700
Mailing Address - Fax:609-677-9060
Practice Address - Street 1:1015 NEW RD
Practice Address - Street 2:SUITE C
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1600
Practice Address - Country:US
Practice Address - Phone:609-677-0700
Practice Address - Fax:609-677-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty