Provider Demographics
NPI:1548714934
Name:ALLURE MEDICAL CENTER PC
Entity type:Organization
Organization Name:ALLURE MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSBLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-851-7111
Mailing Address - Street 1:25 KILMER DR STE 105
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1561
Mailing Address - Country:US
Mailing Address - Phone:732-851-7111
Mailing Address - Fax:732-851-7008
Practice Address - Street 1:25 KILMER DR STE 105
Practice Address - Street 2:
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1561
Practice Address - Country:US
Practice Address - Phone:732-851-7111
Practice Address - Fax:732-851-7008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08697900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ135818OtherABFM