Provider Demographics
NPI:1972044923
Name:MEDICAL SERVICE PROFESSIONALS OF NJ LLC
Entity Type:Organization
Organization Name:MEDICAL SERVICE PROFESSIONALS OF NJ LLC
Other - Org Name:CLOVER HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-457-9145
Mailing Address - Street 1:125 CHUBB AVE STE 100S
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-3504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 CHUBB AVE
Practice Address - Street 2:SUITE 100-S
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-3504
Practice Address - Country:US
Practice Address - Phone:201-559-7600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Multi-Specialty