=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962830257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDI-HOME MEDICAL OF NEW JERSEY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2013
-----------------------------------------------------
Last Update Date | 01/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 HIGH ST
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08060-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-447-3442
-----------------------------------------------------
Fax | 609-447-3443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 HIGH ST SUITE 2A
-----------------------------------------------------
City | MOUNT HOLLY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08060-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-447-3442
-----------------------------------------------------
Fax | 609-447-3443
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAMUEL FRIEDMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 609-447-3442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------