Impact Medical LLC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

26NJ00349900 Issued in NJ

Legal business name

IMPACT MEDICAL LLC

Practice address

244 Aman Ave
Clementon, NJ 08021-2502

Phone

(267) 474-1355

NPI assigned

Dec 4, 2011

Last updated

Dec 4, 2011By 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

Ihuoma Ottih, NP

Title

Apn-C/ Owner

Phone

(267) 474-1355

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1322956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322956800000",
    "number": "1336417476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 AMAN AVE",
            "city": "CLEMENTON",
            "state": "NJ",
            "postal_code": "080212502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 AMAN AVE",
            "city": "CLEMENTON",
            "state": "NJ",
            "postal_code": "080212502",
            "telephone_number": "267-474-1355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPACT MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-04",
        "last_updated": "2011-12-04",
        "status": "A",
        "authorized_official_last_name": "OTTIH",
        "authorized_official_first_name": "IHUOMA",
        "authorized_official_title_or_position": "APN-C/ OWNER",
        "authorized_official_telephone_number": "267-474-1355",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NJ",
            "license": "26NJ00349900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Health Nurse Practitioner in Clementon, NJ
• Providers in Clementon, NJ by specialty
• Adult Health Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2011; 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.