Provider Demographics
NPI:1376989863
Name:LIFEROCK MEDICAL
Entity Type:Organization
Organization Name:LIFEROCK MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ILIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEHU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-294-4791
Mailing Address - Street 1:277 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:277 WAYNE AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-1708
Practice Address - Country:US
Practice Address - Phone:201-294-4791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport