Provider Demographics
NPI:1447244538
Name:IMMEDIATE MEDICAL CARE CENTER
Entity Type:Organization
Organization Name:IMMEDIATE MEDICAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:EARL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-879-7730
Mailing Address - Street 1:2 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2308
Mailing Address - Country:US
Mailing Address - Phone:908-879-7730
Mailing Address - Fax:908-879-4575
Practice Address - Street 1:2 NORTH RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2308
Practice Address - Country:US
Practice Address - Phone:908-879-7730
Practice Address - Fax:908-879-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA052396207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJIM527623Medicare ID - Type Unspecified