Healthcare Provider Details

I. General information

NPI: 1134760754
Provider Name (Legal Business Name): MEDISURE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 INVERNESS DR
TOMS RIVER NJ
08753-6313
US

IV. Provider business mailing address

2310 INVERNESS DR
TOMS RIVER NJ
08753-6313
US

V. Phone/Fax

Practice location:
  • Phone: 732-567-4236
  • Fax:
Mailing address:
  • Phone: 732-567-4236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL SCHWARTZ
Title or Position: PRESIDENT
Credential:
Phone: 732-567-4236