MEDICARE: AEQUOR HEALTHCARE SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	HP0031200	NJ

General Provider Information

NPI Number	:	1063648301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AEQUOR HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	33 WOOD AVE S
Second Line	:	5TH FL
City	:	ISELIN
State	:	NJ
Zip	:	08830-2735
Country	:	US
Telephone Number	:	732-494-4999
Fax Number	:	732-494-4888

Provider Business Practice Location Address
First Line	:	33 WOOD AVE S
Second Line	:	5TH FL
City	:	ISELIN
State	:	NJ
Zip	:	08830-2735
Country	:	US
Telephone Number	:	732-494-4999
Fax Number	:	732-494-4888

Authorized Official
Title or Position	:	CEO
Name	:	MR. MANMEET VIRDI
Credential	:
Telephone Number	:	732-494-4999

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	06/01/2009

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