Healthcare Provider Details

I. General information

NPI: 1386354744
Provider Name (Legal Business Name): IOM TECHNICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MATAWAN RD STE 302
MATAWAN NJ
07747-2653
US

IV. Provider business mailing address

90 MATAWAN RD STE 302
MATAWAN NJ
07747-2653
US

V. Phone/Fax

Practice location:
  • Phone: 173-281-2028
  • Fax:
Mailing address:
  • Phone: 173-281-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name: KATHY SAUNDERS
Title or Position: DIRECTOR OF RCM
Credential:
Phone: 732-812-0281