Healthcare Provider Details

I. General information

NPI: 1912206939
Provider Name (Legal Business Name): EPIC MEDICAL STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MAIN ST STE 2
LAKE COMO NJ
07719-2931
US

IV. Provider business mailing address

1800 MAIN ST STE 2
LAKE COMO NJ
07719-2931
US

V. Phone/Fax

Practice location:
  • Phone: 732-359-7920
  • Fax: 732-359-7921
Mailing address:
  • Phone: 732-359-7920
  • Fax: 732-359-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHPO0143300
License Number StateNJ

VIII. Authorized Official

Name: MR. MICHAEL BOTTON
Title or Position: PRINCIPAL
Credential:
Phone: 732-359-7920