Provider Demographics
NPI:1326298993
Name:IMAI, PAULA T (APRN-BC, CDE)
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:T
Last Name:IMAI
Suffix:
Gender:F
Credentials:APRN-BC, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1163 ROUTE 37 W
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-4973
Mailing Address - Country:US
Mailing Address - Phone:732-736-1000
Mailing Address - Fax:732-736-8811
Practice Address - Street 1:1163 ROUTE 37 W
Practice Address - Street 2:SUITE A-1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4973
Practice Address - Country:US
Practice Address - Phone:732-736-1000
Practice Address - Fax:732-736-8811
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00029400207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082005Medicare PIN