Legendary Support Coordination

Primary specialty

Supports Brokerage AgencyTaxonomy code 251X00000X

Legal business name

LEGENDARY SUPPORT COORDINATION

Practice address

136 Queen Ave
Woodbury Heights, NJ 08097-1635

Phone

(215) 696-2300

NPI assigned

Jun 19, 2019

Organization subpart

No

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

Authorized official

Name

Kaseim EzellNPI 1154781300

Title

Co-Owner

Phone

(215) 696-2300

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kaseim Ezell

  • Durable Medical Equipment & Medical Supplies
  • Collegeville, PA
  • NPI 1154781300
  NPD (past) Authorized official

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

{
    "created_epoch": "1560902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560902400000",
    "number": "1629638838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3908 MONTELLA CIR",
            "city": "COLLEGEVILLE",
            "state": "PA",
            "postal_code": "194261217",
            "telephone_number": "215-696-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 QUEEN AVE",
            "city": "WOODBURY HEIGHTS",
            "state": "NJ",
            "postal_code": "080971635",
            "telephone_number": "215-696-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGENDARY SUPPORT COORDINATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-19",
        "last_updated": "2019-06-19",
        "status": "A",
        "authorized_official_last_name": "EZELL",
        "authorized_official_first_name": "KASEIM",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "215-696-2300"
    },
    "taxonomies": [
        {
            "code": "251X00000X",
            "taxonomy_group": "",
            "desc": "Supports Brokerage",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johanna Kline-Kim, MD
• Bridget Marie Knapp, APN-C
• Shivani Kotwal, DPM
• Robert Laguarina Jr.
• Carol S Lang, EDS LMFT LPC
• Theodore Lempert, DDS
• Michael Jay Liberman, DC
• Lawrence Lo, M.D.
• Angelique S Mason, CRNP
• Bruce Thomas McCabe Jr., ATC

• Supports Brokerage Agency in Woodbury Heights, NJ
• Providers in Woodbury Heights, NJ by specialty
• Supports Brokerage Agency in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; 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.