Provider Demographics
NPI:1275670986
Name:ATLANTIC INTERNAL MEDICINE ASSOCIATES.PA
Entity Type:Organization
Organization Name:ATLANTIC INTERNAL MEDICINE ASSOCIATES.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:LARRABEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-652-9933
Mailing Address - Street 1:310 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4461
Mailing Address - Country:US
Mailing Address - Phone:609-652-9933
Mailing Address - Fax:609-652-9955
Practice Address - Street 1:310 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-9933
Practice Address - Fax:609-652-9955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ195242Medicare ID - Type Unspecified