Healthcare Provider Details

I. General information

NPI: 1427092675
Provider Name (Legal Business Name): PERTH AMBOY HEALTH CARE L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 AMBOY AVENUE
PERTH AMBOY NJ
08861-2595
US

IV. Provider business mailing address

607 AMBOY AVENUE
PERTH AMBOY NJ
08861-2595
US

V. Phone/Fax

Practice location:
  • Phone: 732-442-5444
  • Fax: 732-442-2626
Mailing address:
  • Phone: 732-442-5444
  • Fax: 732-442-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number22620
License Number StateNJ

VIII. Authorized Official

Name: PAULETTE CLAY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 732-442-5444