| Immedicenter | |
|
1355 Broad St Clifton NJ 07013-4221 | |
| (973) 778-5566 | |
| (973) 778-4044 |
| Full Name | Immedicenter |
|---|---|
| Speciality | Family Medicine |
| Location | 1355 Broad St, Clifton, New Jersey |
| Authorized Official Name and Position | Maria C Squirlock (ADMINISTRATOR) |
| Authorized Official Contact | 9737785566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Immedicenter 1355 Broad St Clifton NJ 07013-4221 Ph: (973) 778-5566 | Immedicenter 1355 Broad St Clifton NJ 07013-4221 Ph: (973) 778-5566 |
| NPI Number | 1275639031 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 03/18/2009 |
| Medicare PECOS PAC ID | 0446230718 |
|---|---|
| Medicare Enrollment ID | O20040726000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275639031 | NPI | - | NPPES |
| CB7304 | Other | NJ | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Zamir S Brelvi |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1740213297 PECOS PAC ID: 5991693301 Enrollment ID: I20040308000936 |
| Provider Name | Rosa M Ramos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023280914 PECOS PAC ID: 0042389512 Enrollment ID: I20080523000277 |
| Provider Name | Thomas E Delcasale |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386683266 PECOS PAC ID: 0345433736 Enrollment ID: I20101018000974 |
| Provider Name | Michael P Basista |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639112501 PECOS PAC ID: 9335126077 Enrollment ID: I20101027000627 |
| Provider Name | Riva L Kaynan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1245368554 PECOS PAC ID: 1951542349 Enrollment ID: I20130727000229 |
| Provider Name | Maureen M Kelleher |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710910930 PECOS PAC ID: 8729991088 Enrollment ID: I20140904002404 |
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