Provider Demographics
NPI:1639501786
Name:MYTHIC HEALTH, LLC
Entity Type:Organization
Organization Name:MYTHIC HEALTH, LLC
Other - Org Name:MYTHIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PODOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-898-1569
Mailing Address - Street 1:116 CROW HILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4256
Mailing Address - Country:US
Mailing Address - Phone:732-898-1569
Mailing Address - Fax:
Practice Address - Street 1:116 CROW HILL RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4256
Practice Address - Country:US
Practice Address - Phone:732-898-1569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies