1497095053 NPI number — TITAN HEALTH PARTNERS LLC

Table of content: (NPI 1497095053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497095053 NPI number — TITAN HEALTH PARTNERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TITAN HEALTH PARTNERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASTERA CANCER CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497095053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
629 CRANBURY RD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-4096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-390-7750
Provider Business Mailing Address Fax Number:
732-390-7725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 US HIGHWAY 22EAST
Provider Second Line Business Practice Location Address:
FL 3
Provider Business Practice Location Address City Name:
BRIDGEWATER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-390-7750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LICITRA
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CEO/CHAIRMAN
Authorized Official Telephone Number:
732-390-7750

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6682390018 . This is a "MEDICARE NSC DMERC PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7892570002 . This is a "NSC DMERT PTAN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".