Healthcare Provider Details

I. General information

NPI: 1982495412
Provider Name (Legal Business Name): INNOUT UROLOGY HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WASHINGTON AVE STE J1002
STAFFORD TWP NJ
08050-2801
US

IV. Provider business mailing address

601 WASHINGTON AVE STE J1002
STAFFORD TWP NJ
08050-2801
US

V. Phone/Fax

Practice location:
  • Phone: 888-433-9360
  • Fax: 609-355-4777
Mailing address:
  • Phone: 888-433-9360
  • Fax: 609-355-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEO LIGON
Title or Position: PRESIDENT
Credential: APN
Phone: 888-433-9360