Healthcare Provider Details

I. General information

NPI: 1790114619
Provider Name (Legal Business Name): COMMUNITY SURGICAL SUPPLY OF TOMS RIVER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2013
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GWYNNS MILL CT
OWINGS MILLS MD
21117-3500
US

IV. Provider business mailing address

PO BOX 4686
TOMS RIVER NJ
08754-4686
US

V. Phone/Fax

Practice location:
  • Phone: 800-349-2990
  • Fax:
Mailing address:
  • Phone: 800-349-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: JOHN BRUTHER
Title or Position: CFO
Credential:
Phone: 800-349-2990