Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB10503700 | NJ |
NPI | 1003262783 |
---|---|
Provider Name | Dr. Lauren H Im-Imamura |
First Address | Berkeley Heights, NJ 07922-2104 |
Second Address | Summit, NJ 07901-3533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 17/07/2020 |