Organization
INTAKE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KOUROSH K MORADMAND (SENIOR DIRECTOR)
(937) 422-6038
Entity
Organization
Contact information
Practice address
115 RIVER RD, SUITE 201, EDGEWATER, NJ 07020-1034
(201) 366-4155
Mailing address
115 RIVER RD, SUITE 201, EDGEWATER, NJ 07020-1034
(201) 366-4155
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
—
—
Other
Enumeration date
01/13/2014
Last updated
04/01/2015
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