Organization
DOMINICK CONDO MD PA
Active
Parent organization
MEDVANTX, INC
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
622 BROADWAY, BAYONNE, NJ 07002-3821
(201) 436-2800
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA08097300
NJ
Other
Enumeration date
01/02/2014
Last updated
12/10/2015
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