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General NPI Number Information
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NPI Number | 1861975930
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Entity Type | Organization
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Legal Business Name | TYCE LLC
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 09/13/2018
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Provider Practice Location Address
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Address Line | 513 W MOUNT PLEASANT AVE STE 111
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1725
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Country | US
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Telephone | 917-609-8548
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 MARTINE AVE
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City | PLAINFIELD
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State | NJ
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Zip | 07060-3130
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | GARTH MONDEROY
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Credential |
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Telephone | 917-609-8548
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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 |
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License Number State |
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