Provider Demographics
NPI:1962830257
Name:MEDI-HOME MEDICAL OF NEW JERSEY
Entity Type:Organization
Organization Name:MEDI-HOME MEDICAL OF NEW JERSEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-447-3442
Mailing Address - Street 1:137 HIGH ST
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-1420
Mailing Address - Country:US
Mailing Address - Phone:609-447-3442
Mailing Address - Fax:609-447-3443
Practice Address - Street 1:137 HIGH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-1420
Practice Address - Country:US
Practice Address - Phone:609-447-3442
Practice Address - Fax:609-447-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-23
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ338604OtherMEDICARE PTAN
NJ0406317Medicaid