Provider Demographics
NPI:1427309657
Name:RELIANCE ASPEN AVIDON LLC
Entity type:Organization
Organization Name:RELIANCE ASPEN AVIDON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAFAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-540-8145
Mailing Address - Street 1:1245 SUNNYFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-2219
Mailing Address - Country:US
Mailing Address - Phone:908-499-2519
Mailing Address - Fax:
Practice Address - Street 1:1119 RARITAN RD
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1315
Practice Address - Country:US
Practice Address - Phone:732-540-8145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service