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General NPI Number Information
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NPI Number | 1336491976
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Entity Type | Organization
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Legal Business Name | ALL TOTAL HEALTH CARE
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 51 S PARK ST SUITE 201
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2735
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Country | US
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Telephone | 191-761-8444
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Fax | 888-627-3079
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Provider Business Mailing Address
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Address Line | 51 S PARK ST SUITE 201
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2735
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Country | US
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Telephone | 191-761-8444
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Fax | 888-627-3079
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MAGED BOUTROS
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Credential | M.D.
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Telephone | 19176184446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA08097300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 25MA08097300
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License Number State | NJ
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