Provider Demographics
NPI:1639342686
Name:INTERNAL MEDICINE ASSOCIATES OF BERGEN COUNTY P.C
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF BERGEN COUNTY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-487-3355
Mailing Address - Street 1:15 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4508
Mailing Address - Country:US
Mailing Address - Phone:201-487-3355
Mailing Address - Fax:201-487-0960
Practice Address - Street 1:15 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4508
Practice Address - Country:US
Practice Address - Phone:201-487-3355
Practice Address - Fax:201-487-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07441900207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ527229OtherMEDICARE PROVIDER #