Provider Demographics
NPI:1205251048
Name:ATLANTIC INTEGRATED MEDICINE, LLC
Entity type:Organization
Organization Name:ATLANTIC INTEGRATED MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ONWUKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-748-4199
Mailing Address - Street 1:319 EAST JIMMIE LEEDS ROAD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4124
Mailing Address - Country:US
Mailing Address - Phone:609-748-4199
Mailing Address - Fax:609-748-4112
Practice Address - Street 1:319 E. JIMMIE LEEDS ROAD
Practice Address - Street 2:SUITE 603
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4124
Practice Address - Country:US
Practice Address - Phone:609-748-4199
Practice Address - Fax:609-748-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty