Provider Demographics
NPI:1518186709
Name:APOLLO HEALTH LLC
Entity Type:Organization
Organization Name:APOLLO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:MAPA
Authorized Official - Last Name:BUERANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-408-9585
Mailing Address - Street 1:2142 ROUTE 70
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-4735
Mailing Address - Country:US
Mailing Address - Phone:732-408-9585
Mailing Address - Fax:732-408-9586
Practice Address - Street 1:2142 ROUTE 70
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NJ
Practice Address - Zip Code:08759-4735
Practice Address - Country:US
Practice Address - Phone:732-408-9585
Practice Address - Fax:732-408-9586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07716200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0051136Medicaid
NJ084792Medicare ID - Type Unspecified