Immedicenter Bloomfield

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

IMMEDICENTER BLOOMFIELD

Practice address

557 Broad St
Bloomfield, NJ 07003-2885

Phone

(973) 680-8300

Fax

(973) 743-5601

NPI assigned

Sep 16, 2006

Last updated

Mar 18, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Maria C Squirlock

Title

Administrator

Phone

(973) 778-5566

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jennifer Ellen Levine-Emdur, MS, RD, CNSC

  • Registered Dietitian
  • New Providence, NJ
  • NPI 1821211442
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237334400000",
    "number": "1023114899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032885",
            "telephone_number": "973-680-8300",
            "fax_number": "973-743-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 BROAD ST",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032885",
            "telephone_number": "973-680-8300",
            "fax_number": "973-743-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMEDICENTER BLOOMFIELD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-16",
        "last_updated": "2009-03-18",
        "status": "A",
        "authorized_official_last_name": "SQUIRLOCK",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "973-778-5566",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB4172",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ferdinand Iannaccone, D.O.
• Ayman M Ibrahim, D.O.
• Demiana Ibrahim
• Liza Ibrahim, LPC
• Icare Pharmacy
• Amanda Eve Immerblum, MS, FNP-BC
• Wanda E Ince
• Anthony C Ingenito, MD
• Julio Iniguez, LMFT
• Introspection, Mind,Body&Spirit Center

• Family Medicine Physician in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• Family Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.