Healthcare Provider Details

I. General information

NPI: 1750608279
Provider Name (Legal Business Name): MED-X AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 BORDENTOWN AVE STE 4550
SOUTH AMBOY NJ
08879-1546
US

IV. Provider business mailing address

PO BOX 720
MATAWAN NJ
07747-0720
US

V. Phone/Fax

Practice location:
  • Phone: 732-721-3700
  • Fax: 732-721-2860
Mailing address:
  • Phone: 732-721-3700
  • Fax: 732-721-2860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LEONARD G AUGUST
Title or Position: VICE PRESIDENT
Credential:
Phone: 732-721-2700