Provider Demographics
NPI:1144345182
Name:HILLSBOROUGH INTERNAL MEDICINE
Entity type:Organization
Organization Name:HILLSBOROUGH INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YANTO
Authorized Official - Middle Name:MEIYER
Authorized Official - Last Name:GULTOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-428-4840
Mailing Address - Street 1:87 TIMBERHILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08823
Mailing Address - Country:US
Mailing Address - Phone:732-940-0624
Mailing Address - Fax:
Practice Address - Street 1:491 AMWELL ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844
Practice Address - Country:US
Practice Address - Phone:908-428-4840
Practice Address - Fax:908-281-0336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care