MEDICARE: MD HEALTHCARE SERVICES-NJ, 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	0400517081	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0400517081	OTHER	NJ	CERTIFICATE OF FORMATION NUMBER

General Provider Information

NPI Number	:	1306263025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MD HEALTHCARE SERVICES-NJ, LLC

Provider Business Mailing Address
First Line	:	1512 12TH ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2126
Country	:	US
Telephone Number	:	201-280-4640
Fax Number	:	201-242-5548

Provider Business Practice Location Address
First Line	:	1512 12TH ST
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-2126
Country	:	US
Telephone Number	:	201-280-4640
Fax Number	:	201-242-5548

Authorized Official
Title or Position	:	CEO
Name	:	MS. OLGA GOLFINOPOULOS
Credential	:	CEO
Telephone Number	:	20124255488

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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