1316274046 NPI number — QUALITY MEDICAL AND SURGICAL SUPPLIES, LLC

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 1316274046 NPI number — QUALITY MEDICAL AND SURGICAL SUPPLIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY MEDICAL AND SURGICAL SUPPLIES, LLC
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:
1316274046
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 W PLEASANT AVE
Provider Second Line Business Mailing Address:
#162
Provider Business Mailing Address City Name:
MAYWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07607-1335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-458-1003
Provider Business Mailing Address Fax Number:
973-458-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 MAIN AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PASSAIC
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07055-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-458-1003
Provider Business Practice Location Address Fax Number:
973-458-1009
Provider Enumeration Date:
11/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MANCINI
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
201-951-3680

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0600304070 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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