Healthcare Provider Details

I. General information

NPI: 1992136253
Provider Name (Legal Business Name): AIR AND WATER SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 PRINCETON ST
NUTLEY NJ
07110-1128
US

IV. Provider business mailing address

158 PRINCETON ST
NUTLEY NJ
07110-1128
US

V. Phone/Fax

Practice location:
  • Phone: 201-953-1719
  • Fax:
Mailing address:
  • Phone: 201-953-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNJ

VIII. Authorized Official

Name: SAMIR SOFER
Title or Position: PRESIDENT
Credential:
Phone: 201-953-1719