Organization
ANNANDALE FAMILY PRACTICE LLC
Active
Parent organization
MEDVANTX, INC.
Other names
Annandale Family Practice
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
56 PAYNE RD, SUITE 21, LEBANON, NJ 08833-3262
(908) 238-0100
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA07764100
NJ
Other
Enumeration date
03/06/2013
Last updated
03/06/2013
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