Extended Optimum Medical Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

EXTENDED OPTIMUM MEDICAL SERVICES LLC

Practice address

1130 Route 202
Suite #6 BLDG E
Raritan, NJ 08869-1490

Phone

(908) 644-2650

NPI assigned

Jan 27, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Miss Tawana Lae Grace

Title

Owner

Phone

(908) 644-2650

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1264550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267056000000",
    "number": "1508197799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 WORLDS FAIR DR",
            "address_2": "SUITE110",
            "city": "SOMERSET",
            "state": "NJ",
            "postal_code": "088731346",
            "telephone_number": "908-644-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 ROUTE 202",
            "address_2": "SUITE #6 BLDG E",
            "city": "RARITAN",
            "state": "NJ",
            "postal_code": "088691490",
            "telephone_number": "908-644-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDED OPTIMUM MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-27",
        "last_updated": "2010-02-25",
        "status": "A",
        "authorized_official_last_name": "GRACE",
        "authorized_official_first_name": "TAWANA",
        "authorized_official_middle_name": "LAE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "908-644-2650",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa Duchesneau, LCSW
• Wendy K Dwyer
• Vincent J. Eletto, MD
• Christina Entrup, APRN
• Abigail Ettinger, D.O.
• Kristina Woung Fallon, MA, LPC, NCC
• Robyn Ferrante, M.D.
• Rilwan Folorunso, MSN, CRNP, PMHNP-BC
• Summer R Forte, LSW
• Susan Eileen Foster, OTR

• Home Health Agency in Raritan, NJ
• Providers in Raritan, NJ by specialty
• Home Health Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.