| Medvance Llc | |
|
214 Oak St Ridgewood NJ 07450-2511 | |
| (484) 288-8130 | |
| Not Available |
| Full Name | Medvance Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 214 Oak St, Ridgewood, New Jersey |
| Authorized Official Name and Position | Gazala Dave (OWNER) |
| Authorized Official Contact | 4842888130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medvance Llc 214 Oak St Ridgewood NJ 07450-2511 Ph: () - | Medvance Llc 214 Oak St Ridgewood NJ 07450-2511 Ph: (484) 288-8130 |
| NPI Number | 1801369582 |
|---|---|
| Provider Enumeration Date | 01/06/2019 |
| Last Update Date | 01/02/2021 |
| Medicare PECOS PAC ID | 9133533441 |
|---|---|
| Medicare Enrollment ID | O20210128000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801369582 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gazala Dave |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1467745695 PECOS PAC ID: 4385888064 Enrollment ID: I20140723001569 |
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