NPIMap

Organization Active NPI

Immedicare

  • Health Service Clinic/Center
  • Newark, NJ
National Provider Identifier
1659727550
Registry record updated May 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
25MA6818400 Issued in NJ
Legal business name
IMMEDICARE
Practice address
360 Avenue P
3Rd Floor
Newark, NJ 07105-4802
Phone
(973) 928-8940
NPI assigned
May 10, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2016

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

Authorized official

Name
Raquel Smith
Title
Office Manager
Phone
(973) 643-8383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X 25MA6818400 NJ Primary

Addresses

Primary practice location

360 Avenue P
3Rd Floor
Newark, NJ 07105-4802

Mailing address

360 Avenue P
3Rd Floor
Newark, NJ 07105-4802
Phone (973) 928-8940

National Provider Directory

National Provider Directory

Locations

360 Avenue P
Fl 3
Newark, NJ 07105
Phone (973) 643-8383

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1462838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1659727550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "360 AVENUE P",
            "address_2": "3RD FLOOR",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071054802",
            "telephone_number": "973-928-8940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 AVENUE P",
            "address_2": "3RD FLOOR",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071054802",
            "telephone_number": "973-928-8940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMMEDICARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-10",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RAQUEL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "973-643-8383"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NJ",
            "license": "25MA6818400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.