Healthcare Provider Details

I. General information

NPI: 1265623169
Provider Name (Legal Business Name): TITAN HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 VERONICA AVE SUITE 201
SOMERSET NJ
08873-5002
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 732-246-4882
  • Fax: 732-249-5633
Mailing address:
  • Phone: 732-390-7750
  • Fax: 732-390-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5681750001
License Number StateNJ
# 2
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, PHD
Phone: 732-390-7750