Provider Demographics
NPI:1174629943
Name:IMMEDICENTER TOTOWA
Entity Type:Organization
Organization Name:IMMEDICENTER TOTOWA
Other - Org Name:TOTOWA PIMARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-794-8345
Mailing Address - Street 1:160 UNION BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2666
Mailing Address - Country:US
Mailing Address - Phone:973-790-0090
Mailing Address - Fax:973-790-6070
Practice Address - Street 1:160 UNION BLVD
Practice Address - Street 2:STE 3
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2666
Practice Address - Country:US
Practice Address - Phone:973-790-0090
Practice Address - Fax:973-790-6070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCG1322OtherRAILROAD MEDICARE
NJCG1322OtherRAILROAD MEDICARE
NJ757390Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER