MEDICARE: AUDIT 101 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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1194486662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIT 101 LLC

Provider Business Mailing Address
First Line	:	525 COUNTYLINE ROAD, SUITE 1
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1405
Country	:	US
Telephone Number	:	212-457-6232
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 COUNTYLINE ROAD, SUITE 1
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1405
Country	:	US
Telephone Number	:	212-457-6232
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELIMELECH RUBIN
Credential	:
Telephone Number	:	908-437-8246

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	04/08/2022

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