Provider Demographics
NPI:1902927874
Name:INTEGRATED MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL ASSOCIATES LLC
Other - Org Name:NA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROWEN
Authorized Official - Middle Name:GUMAPAS
Authorized Official - Last Name:DIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-744-7337
Mailing Address - Street 1:48 N FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3411
Mailing Address - Country:US
Mailing Address - Phone:973-744-7337
Mailing Address - Fax:973-744-5035
Practice Address - Street 1:48 N FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3411
Practice Address - Country:US
Practice Address - Phone:973-744-7337
Practice Address - Fax:973-744-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69300207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty