Provider Demographics
NPI:1861826919
Name:INTEGRATED MEDICAL SERVICES PC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLIFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-653-5686
Mailing Address - Street 1:583 BROADWAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07514-2517
Mailing Address - Country:US
Mailing Address - Phone:973-653-5686
Mailing Address - Fax:
Practice Address - Street 1:583 BROADWAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-2517
Practice Address - Country:US
Practice Address - Phone:973-653-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D18991Medicare UPIN