Most Relevant Information
Provider Data
| NPI Number: | 1003262783 |
| Provider Name: | LAUREN H IM-IMAMURA D.O, |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/11/2016 |
| Last Updated: | 07/17/2020 |
Provider Practice Location
99 BEAUVOIR AVE
SUMMIT
NJ
079013533
Practice Location Phone/Fax
| Phone: | 9085222000 |
| Fax: |
Provider Mailing Location
1 DIAMOND HILL RD
BERKELEY HEIGHTS
NJ
079222104
Provider Mailing Phone/Fax
| Phone: | 9089779376 |
| Fax: |