Healthcare Provider Details

I. General information

NPI: 1902569742
Provider Name (Legal Business Name): TITAN HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ROUTE 17 FL 11
RUTHERFORD NJ
07070-2557
US

IV. Provider business mailing address

629 CRANBURY RD FL 2
EAST BRUNSWICK NJ
08816-4096
US

V. Phone/Fax

Practice location:
  • Phone: 201-500-4958
  • Fax: 833-993-1986
Mailing address:
  • Phone: 732-390-7750
  • Fax: 732-390-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD J LICITRA
Title or Position: CEO/CHAIRMAN
Credential: MD
Phone: 732-390-7750