Organization
TRISTATE DOMESTIC,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOMINICK IACOVIELLO (PRESIDENT)
(973) 678-3030
Entity
Organization
Contact information
Practice address
12 EVERETT ST, EAST ORANGE, NJ 07017-1740
(973) 678-3030
Mailing address
12 EVERETT ST, EAST ORANGE, NJ 07017-1740
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
07/04/2007
Last updated
09/11/2025
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