Healthcare Provider Details

I. General information

NPI: 1780296160
Provider Name (Legal Business Name): NJ MOBILE MEDICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 RIVER AVE STE 103
LAKEWOOD NJ
08701-4267
US

IV. Provider business mailing address

67 HOLLY HILL LN STE 102
GREENWICH CT
06830-6072
US

V. Phone/Fax

Practice location:
  • Phone: 212-595-0005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DOV LEVIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 212-595-0005