Provider Demographics
NPI:1154452225
Name:IFURUNG, ARTEMIO AGUSTINES (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTEMIO
Middle Name:AGUSTINES
Last Name:IFURUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 ROSSI RD
Mailing Address - Street 2:
Mailing Address - City:COOKSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08511-1122
Mailing Address - Country:US
Mailing Address - Phone:609-758-7751
Mailing Address - Fax:
Practice Address - Street 1:1108 PEMBERTON BROWNS MILLS RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1501
Practice Address - Country:US
Practice Address - Phone:609-894-9391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA041820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1305102495E2OtherBLUE CROSS BLUE SHIELD
NJ730879-00-05OtherEMPLOYER REGISTRATION
NJ3918602Medicaid
NJ730879-00-05OtherEMPLOYER REGISTRATION
NJ3918602Medicaid