MEDICARE: MY HOME TELEMED 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	261QP2300X	Primary Care Clinic/Center

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	:	1548848906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY HOME TELEMED LLC

Provider Business Mailing Address
First Line	:	106 ANITA DR
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7522
Country	:	US
Telephone Number	:	609-432-5417
Fax Number	:	609-788-8111

Provider Business Practice Location Address
First Line	:	1156 PIEDMONT RD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-4843
Country	:	US
Telephone Number	:	609-432-5417
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CEO
Name	:	DR. DENISE S TRUMBAUER
Credential	:	DNP, APN,BC
Telephone Number	:	609-432-5417

Provider Enumeration Date	:	03/29/2021
Last Update Date	:	03/29/2021

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Directions to “MY HOME TELEMED LLC ” Practice Location

Language	Start Address	Practice Location

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