Organization
AVENEL ISELIN MEDICAL GROUP, LLC
Active
Parent organization
MEDVANTX, INC.
Other names
AVENEL ISELIN MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OPS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
400 GILL LN, 1, ISELIN, NJ 08830-3059
(732) 404-1580
Mailing address
5626 OBERLIN DR, 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA05991500
NJ
Other
Enumeration date
11/29/2012
Last updated
10/04/2024
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