Provider Demographics
NPI:1508989526
Name:HEALTH GUARD
Entity Type:Organization
Organization Name:HEALTH GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF THE COMPANY
Authorized Official - Prefix:MR
Authorized Official - First Name:VALERIY
Authorized Official - Middle Name:
Authorized Official - Last Name:IZRAILOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-254-9155
Mailing Address - Street 1:34 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-1276
Mailing Address - Country:US
Mailing Address - Phone:732-617-9251
Mailing Address - Fax:
Practice Address - Street 1:646 STATE ROUTE 18 BLDG B STE 110
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3722
Practice Address - Country:US
Practice Address - Phone:732-254-9155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ7356901343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7356901Medicaid