Basic Information
| Provider Information | |||||||||
| NPI: | 1780626499 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMO MEDICAL CARE LLC | ||||||||
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| OtherOrganizationName: | EMEDICAL OFFICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 740557 | ||||||||
| Address2: | DEPT 10016 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8882338826 | ||||||||
| FaxNumber: | 6022628890 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 KINGS HWY E | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077483509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4694012386 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 09/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | KONDAS | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | NJ | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 0822900001 | 01 | NJ | MEDICARE DME | OTHER | CK4245 | 01 | NJ | RAILROAD MEDICARE | OTHER |