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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