Provider Demographics
NPI:1306057757
Name:TOWN TOTAL HEALTH NEWARK LLC
Entity type:Organization
Organization Name:TOWN TOTAL HEALTH NEWARK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VITO
Authorized Official - Middle Name:ANGELO
Authorized Official - Last Name:DITURI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:973-757-1200
Mailing Address - Street 1:393 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-2842
Mailing Address - Country:US
Mailing Address - Phone:973-757-1200
Mailing Address - Fax:
Practice Address - Street 1:393 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2842
Practice Address - Country:US
Practice Address - Phone:973-757-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS006578003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0099716Medicaid
NJ0099716Medicaid