Provider Demographics
NPI:1306263025
Name:MD HEALTHCARE SERVICES-NJ, LLC
Entity type:Organization
Organization Name:MD HEALTHCARE SERVICES-NJ, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLFINOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:2012-425-5488
Mailing Address - Street 1:1512 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2126
Mailing Address - Country:US
Mailing Address - Phone:201-280-4640
Mailing Address - Fax:201-242-5548
Practice Address - Street 1:1512 12TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2126
Practice Address - Country:US
Practice Address - Phone:201-280-4640
Practice Address - Fax:201-242-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400517081251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0400517081OtherCERTIFICATE OF FORMATION NUMBER