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General NPI Number Information
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NPI Number | 1306263025
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Entity Type | Organization
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Legal Business Name | MD HEALTHCARE SERVICES-NJ, LLC
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 1512 12TH ST
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City | FORT LEE
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State | NJ
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Zip | 07024-2126
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Country | US
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Telephone | 201-280-4640
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Fax | 201-242-5548
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Provider Business Mailing Address
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Address Line | 1512 12TH ST
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City | FORT LEE
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State | NJ
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Zip | 07024-2126
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Country | US
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Telephone | 201-280-4640
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Fax | 201-242-5548
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Authorized Official
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Title or Position | CEO
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Name | MS. OLGA GOLFINOPOULOS
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Credential | CEO
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Telephone | 20124255488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 0400517081
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License Number State | NJ
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