Healthcare Provider Details

I. General information

NPI: 1013565332
Provider Name (Legal Business Name): NASPAC1 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2019
Last Update Date: 01/18/2021
Certification Date: 01/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 ROUTE 42 STE C
BLACKWOOD NJ
08012-1782
US

IV. Provider business mailing address

404 CREEK CROSSING BLVD # 404
HAINESPORT NJ
08036-2768
US

V. Phone/Fax

Practice location:
  • Phone: 856-516-4566
  • Fax: 856-516-4577
Mailing address:
  • Phone: 609-410-9424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANJAY CHEULKAR
Title or Position: COO
Credential:
Phone: 609-410-9424