Healthcare Provider Details

I. General information

NPI: 1841442670
Provider Name (Legal Business Name): IN HOME LYMPHATIC CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HIGHLAND DR
JACKSON NJ
08527-1235
US

IV. Provider business mailing address

17 HIGHLAND DR
JACKSON NJ
08527-1235
US

V. Phone/Fax

Practice location:
  • Phone: 732-291-3705
  • Fax: 732-291-0787
Mailing address:
  • Phone: 732-291-3705
  • Fax: 732-291-0787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL GERARD LUPO
Title or Position: CFO
Credential:
Phone: 732-291-3705