Provider Demographics
NPI:1891874723
Name:ROCHELLE PARK MEDICAL CENTER PA
Entity Type:Organization
Organization Name:ROCHELLE PARK MEDICAL CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:IMBORNONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-291-1010
Mailing Address - Street 1:96 PARKWAY
Mailing Address - Street 2:ROCHELLE PARK MEDICAL CENTER PA
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662
Mailing Address - Country:US
Mailing Address - Phone:201-291-1010
Mailing Address - Fax:201-587-0313
Practice Address - Street 1:96 PARKWAY
Practice Address - Street 2:ROCHELLE PARK MEDICAL CENTER PA
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662
Practice Address - Country:US
Practice Address - Phone:201-291-1010
Practice Address - Fax:201-587-0313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty