=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720642226
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALLIEDMEDPLUS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2019
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 S LIVINGSTON AVE STE 208
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-992-0733
-----------------------------------------------------
Fax | 973-992-0734
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 S LIVINGSTON AVE STE 208
-----------------------------------------------------
City | LIVINGSTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07039-5415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-992-0733
-----------------------------------------------------
Fax | 973-992-0734
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | OWEN LEGASPI
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 973-992-0733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------