Provider Demographics
NPI:1346439296
Name:ADVANCED INTERNAL CARE OF CENTRAL JERSEY
Entity Type:Organization
Organization Name:ADVANCED INTERNAL CARE OF CENTRAL JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-840-5395
Mailing Address - Street 1:1230 E CHAMPLAIN DR APT 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5067
Mailing Address - Country:US
Mailing Address - Phone:559-840-5395
Mailing Address - Fax:
Practice Address - Street 1:906 OAK TREE AVE STE A
Practice Address - Street 2:
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5127
Practice Address - Country:US
Practice Address - Phone:559-840-5395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069694261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center