# WATER STREET PHYSICIANS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1063730281
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (SR DIRECTOR OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 300 W WATER ST, TOMS RIVER, NJ 08753-6692
- **Practice address phone:** (732) 349-4030
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 25MB02891000 | NJ | Yes |

## Other

- **Enumeration date:** 05/12/2010
- **Last updated:** 10/23/2012