Healthcare Provider Details

I. General information

NPI: 1669861761
Provider Name (Legal Business Name): LONDON PRIVATE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 07/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1301
US

IV. Provider business mailing address

989 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1301
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-9300
  • Fax: 973-429-9302
Mailing address:
  • Phone: 973-429-9300
  • Fax: 973-429-9302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number28RS00738200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TANUP PATEL
Title or Position: OWNER, PIC
Credential: PHARM D.
Phone: 908-331-3426