Provider Demographics
NPI:1982763371
Name:REGIONAL INTERNAL MEDICINE ASSOCIATES, PC
Entity type:Organization
Organization Name:REGIONAL INTERNAL MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAFAT
Authorized Official - Middle Name:SULTANA
Authorized Official - Last Name:CHOUDHRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-652-4141
Mailing Address - Street 1:1004 SOUTH NEW ROAD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3730
Mailing Address - Country:US
Mailing Address - Phone:609-652-4141
Mailing Address - Fax:609-652-9939
Practice Address - Street 1:1004 S NEW RD
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3730
Practice Address - Country:US
Practice Address - Phone:609-652-4141
Practice Address - Fax:609-652-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06763700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG81287Medicare UPIN
NJ1982763371Medicare PIN