Organization
LIVING WELL MEDICAL SUPPORT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALFRED T. C. PENG M.D. (MANAGER)
(561) 251-6781
Entity
Organization
Contact information
Practice address
78 EASTON AVE, FIRST FLOOR, NEW BRUNSWICK, NJ 08901-1885
(732) 828-1003
(732) 828-0775
Mailing address
214 HIDDEN WOODS CT, PISCATAWAY, NJ 08854-3060
(561) 251-6781
(561) 994-3549
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
25MA05520200
NJ
Other
Enumeration date
09/24/2008
Last updated
02/23/2009
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