Healthcare Provider Details

I. General information

NPI: 1184250078
Provider Name (Legal Business Name): MSAK VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BRICK BLVD STE 203
BRICK NJ
08723-6079
US

IV. Provider business mailing address

445 BRICK BLVD STE 203
BRICK NJ
08723-6079
US

V. Phone/Fax

Practice location:
  • Phone: 732-551-3880
  • Fax:
Mailing address:
  • Phone: 732-551-3880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN PETZOLD
Title or Position: PRESIDENT
Credential:
Phone: 732-551-3880