Intake, LLC

Primary specialty

Supports Brokerage AgencyTaxonomy code 251X00000X

Legal business name

INTAKE, LLC

Practice address

115 River Rd
Suite 201
Edgewater, NJ 07020-1034

Phone

(201) 366-4155

NPI assigned

Jan 13, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Kourosh K Moradmand

Title

Senior Director

Phone

(937) 422-6038

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427846400000",
    "number": "1629490586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 RIVER RD",
            "address_2": "SUITE 201",
            "city": "EDGEWATER",
            "state": "NJ",
            "postal_code": "070201034",
            "telephone_number": "201-366-4155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 RIVER RD",
            "address_2": "SUITE 201",
            "city": "EDGEWATER",
            "state": "NJ",
            "postal_code": "070201034",
            "telephone_number": "201-366-4155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2015-04-01",
        "status": "A",
        "authorized_official_last_name": "MORADMAND",
        "authorized_official_first_name": "KOUROSH",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SENIOR DIRECTOR",
        "authorized_official_telephone_number": "937-422-6038",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Edgewater, NJ by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2015; 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.