Provider Demographics
NPI:1811086465
Name:ATLANTIC INDUSTRIAL MEDICAL CLINIC
Entity type:Organization
Organization Name:ATLANTIC INDUSTRIAL MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGALAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-348-2211
Mailing Address - Street 1:705 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE F-4
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-1468
Mailing Address - Country:US
Mailing Address - Phone:609-407-6800
Mailing Address - Fax:609-646-7247
Practice Address - Street 1:1 S NEW YORK AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-8012
Practice Address - Country:US
Practice Address - Phone:609-348-2211
Practice Address - Fax:609-348-2264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA28438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3099202Medicaid
NJ527277Medicare PIN
NJC53238Medicare UPIN