MEDICARE: EPIC MEDICAL STAFFING, 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	HPO0143300	NJ

General Provider Information

NPI Number	:	1912206939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC MEDICAL STAFFING, LLC

Provider Business Mailing Address
First Line	:	1800 MAIN ST STE 2
Second Line	:
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2931
Country	:	US
Telephone Number	:	732-359-7920
Fax Number	:	732-359-7921

Provider Business Practice Location Address
First Line	:	1800 MAIN ST STE 2
Second Line	:
City	:	LAKE COMO
State	:	NJ
Zip	:	07719-2931
Country	:	US
Telephone Number	:	732-359-7920
Fax Number	:	732-359-7921

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MR. MICHAEL BOTTON
Credential	:
Telephone Number	:	732-359-7920

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	03/18/2011

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