=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225141542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ION HEALTHCARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/17/2006
-----------------------------------------------------
Last Update Date | 11/25/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 452 OLD HOOK RD STE 102
-----------------------------------------------------
City | EMERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07630-1391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-261-1119
-----------------------------------------------------
Fax | 201-261-1189
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 452 OLD HOOK RD STE 102
-----------------------------------------------------
City | EMERSON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07630-1381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-261-1119
-----------------------------------------------------
Fax | 201-261-1189
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. STEPHEN A BURTON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 804-241-7931
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------