Organization
FAMILY MEDICINE ASSOCIATES OF ITHACA
Active
Parent organization
MEDVANTX, INC
Other names
Family Medicine Associates- Brentwood
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
8 BRENTWOOD DR, ITHACA, NY 14850-1871
(607) 277-4341
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
126988
NY
Other
Enumeration date
07/22/2014
Last updated
01/04/2016
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