Healthcare Provider Details

I. General information

NPI: 1063130847
Provider Name (Legal Business Name): IEJTWINS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 REGIS AVE
PITTSBURGH PA
15236-1419
US

IV. Provider business mailing address

3526 BROWNSVILLE RD
PITTSBURGH PA
15227-3116
US

V. Phone/Fax

Practice location:
  • Phone: 412-662-0095
  • Fax:
Mailing address:
  • Phone: 412-884-5650
  • Fax: 412-884-5651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ADAM RICE
Title or Position: PRESIDENT
Credential: PHARMD
Phone: 412-559-5386