Provider Demographics
NPI:1184994188
Name:MEDICAL HOUSE CALL ASSOCIATES
Entity type:Organization
Organization Name:MEDICAL HOUSE CALL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APN-C/CEO
Authorized Official - Prefix:
Authorized Official - First Name:IHUOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTIH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:267-474-1355
Mailing Address - Street 1:244 AMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEMENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2502
Mailing Address - Country:US
Mailing Address - Phone:856-345-0444
Mailing Address - Fax:
Practice Address - Street 1:536 WHITE HORSE PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049
Practice Address - Country:US
Practice Address - Phone:856-345-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0361518Medicaid
NJ613460090OtherMEDICARE DCN