Provider Demographics
NPI:1962627059
Name:INTEGRATED MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BART
Authorized Official - Last Name:MENASHE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-237-2200
Mailing Address - Street 1:687 ATLANTIC CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08721-2539
Mailing Address - Country:US
Mailing Address - Phone:732-237-2200
Mailing Address - Fax:732-606-9264
Practice Address - Street 1:687 ATLANTIC CITY BLVD
Practice Address - Street 2:
Practice Address - City:BAYVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08721-2539
Practice Address - Country:US
Practice Address - Phone:732-237-2200
Practice Address - Fax:732-606-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04647400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty