Healthcare Provider Details

I. General information

NPI: 1629773601
Provider Name (Legal Business Name): TUCKERMAN OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 TUCKERMAN LN
ROCKVILLE MD
20852-4683
US

IV. Provider business mailing address

5550 TUCKERMAN LN
ROCKVILLE MD
20852-4683
US

V. Phone/Fax

Practice location:
  • Phone: 732-903-1958
  • Fax:
Mailing address:
  • Phone: 732-903-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MINDEE DRILLMAN
Title or Position: MEDICARE ADMINISTRATION OFFICER
Credential:
Phone: 845-825-2217