Provider Demographics
NPI:1194109231
Name:IMHOF, ALICE SHERRINGTON
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:SHERRINGTON
Last Name:IMHOF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1805
Mailing Address - Country:US
Mailing Address - Phone:732-930-4038
Mailing Address - Fax:
Practice Address - Street 1:33 CORBETT WAY
Practice Address - Street 2:NEW LEAF FLORIDA LLC
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724
Practice Address - Country:US
Practice Address - Phone:631-338-7860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00743300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist