Legendary Support Coordination

NPI #1629638838 in Woodbury Heights, New Jersey

Provider Information

NPI Number: 1629638838
Entity Type: Organization
Organization Name: Legendary Support Coordination
Primary Specialty: Supports Brokerage
Enumeration Date: Jun 19, 2019
Last Updated: Jun 19, 2019

Practice Location

Address: 136 QUEEN AVE
City: Woodbury Heights
State: New Jersey
ZIP Code: 08097-1635
Phone: (215) 696-2300

Authorized Official

Name: KASEIM EZELL
Title: CO-OWNER
Phone: (215) 696-2300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Supports Brokerage	251X00000X	Primary

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