Healthcare Provider Details

I. General information

NPI: 1881844041
Provider Name (Legal Business Name): MEDCOM HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2008
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

IV. Provider business mailing address

258 N NEW RD
PLEASANTVILLE NJ
08232-2170
US

V. Phone/Fax

Practice location:
  • Phone: 609-646-4064
  • Fax:
Mailing address:
  • Phone: 609-646-4064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ILYAS RAJPUT
Title or Position: OWNER
Credential: MD
Phone: 609-646-4064