Provider Demographics
NPI:1194334870
Name:INDEPENDENT GERIATRIC PROFESSIONALS OF NJ PC
Entity type:Organization
Organization Name:INDEPENDENT GERIATRIC PROFESSIONALS OF NJ PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-294-8435
Mailing Address - Street 1:2500 DEKALB PIKE STE 301
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-2007
Mailing Address - Country:US
Mailing Address - Phone:484-965-9566
Mailing Address - Fax:484-965-9567
Practice Address - Street 1:902 JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016-3858
Practice Address - Country:US
Practice Address - Phone:609-239-3900
Practice Address - Fax:609-239-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty