Organization
FASTRAD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JORDAN WEXLER (MENBER)
(732) 905-1008
Entity
Organization
Contact information
Practice address
405 CANDLEWOOD COMMONS, HOWELL, NJ 07731-2171
(732) 905-1008
(732) 905-1207
Mailing address
405 CANDLEWOOD COMMONS, HOWELL, NJ 07731-2171
(732) 905-1008
(732) 905-1207
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
146061
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146061
MEDICARE PTAN PROVIDER NUMBER
NJ
Enumeration date
05/01/2009
Last updated
05/01/2009
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