Provider Demographics
NPI:1902045966
Name:TOTAL MEDICAL CARE
Entity Type:Organization
Organization Name:TOTAL MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AXAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-790-1074
Mailing Address - Street 1:204 HALEDON AVE
Mailing Address - Street 2:
Mailing Address - City:PROSPECT PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-2023
Mailing Address - Country:US
Mailing Address - Phone:973-790-1074
Mailing Address - Fax:973-790-1929
Practice Address - Street 1:204 HALEDON AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:NJ
Practice Address - Zip Code:07508-2023
Practice Address - Country:US
Practice Address - Phone:973-790-1074
Practice Address - Fax:973-790-1929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06601600261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care