Provider Demographics
NPI:1538419148
Name:I.M.E.M. CLINICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:I.M.E.M. CLINICAL ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HILLEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-353-9069
Mailing Address - Street 1:500 RIVER AVE
Mailing Address - Street 2:STE 255
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-4738
Mailing Address - Country:US
Mailing Address - Phone:417-353-9069
Mailing Address - Fax:417-429-2893
Practice Address - Street 1:500 RIVER AVE
Practice Address - Street 2:STE 255
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4738
Practice Address - Country:US
Practice Address - Phone:917-734-3322
Practice Address - Fax:845-503-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07628300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty