MEDICARE: TOTAL HEALTH SOLUTIONS PC

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	207R00000X	Internal Medicine Physician	4523300	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
2	223963013	OTHER	NJ	QUALCARE

General Provider Information

NPI Number	:	1285927442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL HEALTH SOLUTIONS PC

Provider Business Mailing Address
First Line	:	95 CRESCENT DR
Second Line	:
City	:	RINGWOOD
State	:	NJ
Zip	:	07456-1108
Country	:	US
Telephone Number	:	201-770-1370
Fax Number	:

Provider Business Practice Location Address
First Line	:	5809 MADISON ST
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-1289
Country	:	US
Telephone Number	:	201-770-1370
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT ZWITIASHVILI
Credential	:	MD
Telephone Number	:	973-767-7648

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	07/02/2011

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