Healthcare Provider Details

I. General information

NPI: 1265706154
Provider Name (Legal Business Name): DUCHESS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E EMERALD AVE
WESTMONT NJ
08108-2508
US

IV. Provider business mailing address

438 E EMERALD AVE
WESTMONT NJ
08108-2508
US

V. Phone/Fax

Practice location:
  • Phone: 914-980-7106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHARLES KILLELEA III
Title or Position: CHAIRMAN & CEO
Credential:
Phone: 914-980-7106