MEDICARE: MT PROSPECT PHARMACEUTICAL SERVICES INC

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	332B00000X	Durable Medical Equipment & Medical Supplies		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083133961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT PROSPECT PHARMACEUTICAL SERVICES INC

Provider Business Mailing Address
First Line	:	794 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3221
Country	:	US
Telephone Number	:	973-483-4749
Fax Number	:	973-482-0643

Provider Business Practice Location Address
First Line	:	794 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-3221
Country	:	US
Telephone Number	:	973-483-4749
Fax Number	:	973-482-0643

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MATTHEW JOSEPH PARISI JR.
Credential	:
Telephone Number	:	973-483-4749

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	07/21/2022

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