Healthcare Provider Details

I. General information

NPI: 1295293264
Provider Name (Legal Business Name): INDIA MOBLIE PHLEBOTOMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 ROBIN LN
TOMS RIVER NJ
08755-3621
US

IV. Provider business mailing address

2139 ROBIN LN
TOMS RIVER NJ
08755-3621
US

V. Phone/Fax

Practice location:
  • Phone: 732-814-0214
  • Fax:
Mailing address:
  • Phone: 732-814-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MAFATIMA SARTIN
Title or Position: PHLEBOTOMY TECHNICIAN/
Credential:
Phone: 732-814-0214