Provider Demographics
NPI:1346595584
Name:QUALITY MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:QUALITY MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SARWAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-693-5006
Mailing Address - Street 1:PO BOX 1550
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-1550
Mailing Address - Country:US
Mailing Address - Phone:609-693-5006
Mailing Address - Fax:609-693-5016
Practice Address - Street 1:1044 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-1051
Practice Address - Country:US
Practice Address - Phone:609-693-5006
Practice Address - Fax:609-693-5016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06588900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7402601Medicaid
NJ7402601Medicaid