Provider Demographics
NPI:1649327792
Name:OSTEOPATHIC INTERNAL MEDICINE ASSOCIATES INC.
Entity type:Organization
Organization Name:OSTEOPATHIC INTERNAL MEDICINE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEJMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-868-2507
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:814-868-2529
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:2010 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2004
Practice Address - Country:US
Practice Address - Phone:814-868-5481
Practice Address - Fax:814-864-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
PAOS003106L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007339400002OtherMA
PA6264810001Medicare NSC
PA0007339400002OtherMA