Provider Demographics
NPI:1528125333
Name:TITAN HEALTH PARTNERS LLC
Entity type:Organization
Organization Name:TITAN HEALTH PARTNERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LICITRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:732-390-7750
Mailing Address - Street 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:629 CRANBURY RD FL 2
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4096
Practice Address - Country:US
Practice Address - Phone:732-390-7750
Practice Address - Fax:732-390-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6682390003OtherNSC DMERC ID#
NJ6682390003OtherNSC-DMERC
NJB76533Medicare UPIN
NJI39716Medicare UPIN
NJD06914Medicare UPIN
NJI63926Medicare UPIN
NJS90695Medicare UPIN
NJQ21301Medicare UPIN
NJ0946540001Medicare NSC
NJH23304Medicare UPIN
NJH28443Medicare UPIN
NJQ30036Medicare UPIN