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General NPI Number Information
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NPI Number | 1669022125
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Entity Type | Individual
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Provider Name | KEVIN EUSTACE IDMT
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Gender | Male
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Dates
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Enumeration Date | 09/17/2019
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 1 ESSEX LN
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-1406
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Country | US
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Telephone | 848-391-1549
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Fax |
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Provider Business Mailing Address
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Address Line | 1 ESSEX LN
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City | OLD BRIDGE
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State | NJ
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Zip | 08857-1406
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Country | US
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Telephone | 848-391-1549
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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