Healthcare Provider Details

I. General information

NPI: 1760058853
Provider Name (Legal Business Name): PRECIOUS LIFE MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 02/01/2023
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 200A
AVENEL NJ
07001-1330
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 200A
AVENEL NJ
07001-1330
US

V. Phone/Fax

Practice location:
  • Phone: 732-444-4646
  • Fax:
Mailing address:
  • Phone: 732-444-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FARDOSE RANA
Title or Position: OWNER
Credential: MSC, RDMS
Phone: 732-444-4646