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Organization

LEGENDARY SUPPORT COORDINATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KASEIM EZELL (CO-OWNER)
(215) 696-2300
Entity
Organization

Contact information

Practice address
136 QUEEN AVE, WOODBURY HEIGHTS, NJ 08097-1635
(215) 696-2300
Mailing address
3908 MONTELLA CIR, COLLEGEVILLE, PA 19426-1217
(215) 696-2300

Taxonomy

Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary

Other

Enumeration date
06/19/2019
Last updated
06/19/2019
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  • EDI platform