Provider Demographics
NPI:1770623027
Name:INTERNAL MEDICINE ASSOCIATES OF MONMOUTH, PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF MONMOUTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MPH
Authorized Official - Phone:732-229-0509
Mailing Address - Street 1:145 WYCKOFF RD STE 202A
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1878
Mailing Address - Country:US
Mailing Address - Phone:732-229-0509
Mailing Address - Fax:732-571-0019
Practice Address - Street 1:145 WYCKOFF RD STE 202A
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1878
Practice Address - Country:US
Practice Address - Phone:732-229-0509
Practice Address - Fax:732-571-0019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ017584Medicare ID - Type Unspecified