Provider Demographics
NPI:1528108560
Name:DOCTOR'S MEDICAL CLINIC PA
Entity type:Organization
Organization Name:DOCTOR'S MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:LOSA
Authorized Official - Last Name:LIM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:201-200-2626
Mailing Address - Street 1:119 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2500
Mailing Address - Country:US
Mailing Address - Phone:201-200-2626
Mailing Address - Fax:
Practice Address - Street 1:119 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2500
Practice Address - Country:US
Practice Address - Phone:201-200-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04954300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty