| Organization Name: | IMPACT MEDICAL LLC |
| NPI Number: | 1336417476 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | IHUOMA OTTIH (APN-C/ OWNER) |
| Mailing Address: | 244 Aman Ave Clementon |
| State: | NJ US |
| Postal Code: | 080212502 |
| Phone Number: | 2674741355 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2011 |
| NPI Last Update Date: | 12/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 26NJ00349900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |