# AVENEL ISELIN MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** AVENEL ISELIN MEDICAL GROUP
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1669717864
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (VP OPS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 400 GILL LN, 1, ISELIN, NJ 08830-3059
- **Practice address phone:** (732) 404-1580
- **Mailing address:** 5626 OBERLIN DR, 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 25MA05991500 | NJ | Yes |

## Other

- **Enumeration date:** 11/29/2012
- **Last updated:** 10/04/2024