Provider Demographics
NPI:1972194215
Name:SKYHEART MEDICAL LLC
Entity type:Organization
Organization Name:SKYHEART MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MOHAMMED
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:973-343-5660
Mailing Address - Street 1:634 EAGLE ROCK AVE UNIT 202
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-6801
Mailing Address - Country:US
Mailing Address - Phone:973-343-5660
Mailing Address - Fax:833-978-0843
Practice Address - Street 1:1126 DICKINSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07201-2404
Practice Address - Country:US
Practice Address - Phone:973-343-5660
Practice Address - Fax:833-978-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty