Provider Demographics
NPI:1760941215
Name:INTERNAL MEDICINE ASSOCIATES OF CENTRAL JERSEY
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF CENTRAL JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-356-0990
Mailing Address - Street 1:1804 OAK TREE RD STE 3
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2783
Mailing Address - Country:US
Mailing Address - Phone:732-494-0080
Mailing Address - Fax:
Practice Address - Street 1:1804 OAK TREE RD STE 3
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2783
Practice Address - Country:US
Practice Address - Phone:732-494-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200235OtherLICENSE