1275789281 NPI number — ADVANCED ORTHOMEDICAL SUPPLIES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275789281 NPI number — ADVANCED ORTHOMEDICAL SUPPLIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED ORTHOMEDICAL SUPPLIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275789281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4461 11TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG ISLAND CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11101-5117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-855-2300
Provider Business Mailing Address Fax Number:
516-977-0412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4461 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-855-2300
Provider Business Practice Location Address Fax Number:
516-977-0412
Provider Enumeration Date:
08/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GROMUL
Authorized Official First Name:
MARIUSZ
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-855-2300

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  915661944 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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