Basic Information
| Provider Information | |||||||||
| NPI: | 1447244538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMMEDIATE MEDICAL CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079302308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088797730 | ||||||||
| FaxNumber: | 9088794575 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 NORTH RD | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079302308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9088797730 | ||||||||
| FaxNumber: | 9088794575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | EARL | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9088797730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MA052396 | NJ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.