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Organization
STAFFORD MEDICAL PA
Active
Organization
STAFFORD MEDICAL PA
Active
Parent organization
MEDVANTX INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX INC
Authorized official
KENNY HEINE (VP OPS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
1364 ROUTE 72 W, 2, MANAHAWKIN, NJ 08050-2485
(609) 597-3416
Mailing address
5626 OBERLIN DR, 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA066536
NJ
Other
Enumeration date
01/09/2013
Last updated
01/09/2013
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