MEDICARE: TOWN TOTAL HEALTH NEWARK 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	3336C0003X	Community/Retail Pharmacy	28RS00657800	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	:	1306057757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWN TOTAL HEALTH NEWARK LLC

Provider Business Mailing Address
First Line	:	393 CENTRAL AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2842
Country	:	US
Telephone Number	:	973-757-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	393 CENTRAL AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103-2842
Country	:	US
Telephone Number	:	973-757-1200
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	MR. VITO ANGELO DITURI
Credential	:	RPH
Telephone Number	:	973-757-1200

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	03/04/2013

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