Provider Demographics
NPI:1326073305
Name:UNION INTERNAL MEDICINE GROUP PA
Entity Type:Organization
Organization Name:UNION INTERNAL MEDICINE GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEFILIPPIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-688-2480
Mailing Address - Street 1:2027 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6013
Mailing Address - Country:US
Mailing Address - Phone:908-688-2480
Mailing Address - Fax:908-688-7518
Practice Address - Street 1:2027 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-6013
Practice Address - Country:US
Practice Address - Phone:908-688-2480
Practice Address - Fax:908-688-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2715309Medicaid
586891Medicare ID - Type Unspecified