1053345470 NPI number — NEWBRIDGE SURGICAL SUPPLIES, INC.

Table of content: (NPI 1053345470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053345470 NPI number — NEWBRIDGE SURGICAL SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWBRIDGE SURGICAL 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:
6
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:
1053345470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 121128
Provider Second Line Business Mailing Address:
DEPT 1128
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75312-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
409-951-6437
Provider Business Mailing Address Fax Number:
409-654-2068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 HICKSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BETHPAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11714-3471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-349-4520
Provider Business Practice Location Address Fax Number:
516-349-4549
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KALTRIDER
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
203-837-2330

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02656866 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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