MEDICARE: ALPHA MEDICAL CARE SERVICES 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	:	1316186695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA MEDICAL CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1111 RIVER RD
Second Line	:	SUITE B14
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1335
Country	:	US
Telephone Number	:	201-696-0926
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 RIVER RD
Second Line	:	SUITE B14
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1335
Country	:	US
Telephone Number	:	201-696-0926
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREY MILVIDSKIY
Credential	:
Telephone Number	:	201-696-0926

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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