1760985428 NPI number — UNION CITY MEDICAL SUPPLIES INC.

Table of content: (NPI 1760985428)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760985428 NPI number — UNION CITY MEDICAL SUPPLIES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNION CITY MEDICAL 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:
BIO DYNAMIC TECHNOLOGIES, INC
Provider Other Organization Name Type Code:
3
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:
1760985428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MADISON ST STE A4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST RUTHERFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07073-1605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-879-2276
Provider Business Mailing Address Fax Number:
800-866-8011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 DEARFIELD DR STE 201A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06831-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-879-2276
Provider Business Practice Location Address Fax Number:
800-866-8011
Provider Enumeration Date:
03/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
FELIX
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
800-879-2276

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A396067 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 008078684 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45127 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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