Provider Demographics
NPI:1083330344
Name:INNOVATIVE HEALTH SOLUTIONS
Entity type:Organization
Organization Name:INNOVATIVE HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARBEN
Authorized Official - Middle Name:CASEM
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-844-4333
Mailing Address - Street 1:92 W HILL RD
Mailing Address - Street 2:
Mailing Address - City:COLONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07067-3811
Mailing Address - Country:US
Mailing Address - Phone:718-844-4333
Mailing Address - Fax:
Practice Address - Street 1:92 W HILL RD
Practice Address - Street 2:
Practice Address - City:COLONIA
Practice Address - State:NJ
Practice Address - Zip Code:07067-3811
Practice Address - Country:US
Practice Address - Phone:718-844-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography