Provider Demographics
NPI:1619216876
Name:ADVANCED MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:ADVANCED MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-928-5101
Mailing Address - Street 1:15 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2627
Mailing Address - Country:US
Mailing Address - Phone:973-928-5101
Mailing Address - Fax:973-928-5102
Practice Address - Street 1:1450 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2145
Practice Address - Country:US
Practice Address - Phone:973-928-5101
Practice Address - Fax:973-928-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09082500207R00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty