Provider Demographics
NPI:1861949984
Name:BEACON INFUSION HEALTH SERVICES LLC
Entity type:Organization
Organization Name:BEACON INFUSION HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-882-1835
Mailing Address - Street 1:1075 STEPHENSON AVENUE
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:OCEANPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:07757
Mailing Address - Country:US
Mailing Address - Phone:609-450-8872
Mailing Address - Fax:949-724-3345
Practice Address - Street 1:1075 STEPHENSON AVENUE
Practice Address - Street 2:SUITE D-2
Practice Address - City:OCEANPORT
Practice Address - State:NJ
Practice Address - Zip Code:07757
Practice Address - Country:US
Practice Address - Phone:609-450-8872
Practice Address - Fax:949-724-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center