Healthcare Provider Details

I. General information

NPI: 1659455046
Provider Name (Legal Business Name): HEALTH CARE DEPOT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2177 OAK TREE RD STE 202
EDISON NJ
08820-1082
US

IV. Provider business mailing address

14440 CHERRY LANE COURT STE 115
LAUREL MD
20707
US

V. Phone/Fax

Practice location:
  • Phone: 732-761-9600
  • Fax: 732-761-1000
Mailing address:
  • Phone: 888-992-1363
  • Fax: 888-992-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier8124400
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name: MR. DAVE PATEL
Title or Position: PRESIDENT
Credential:
Phone: 888-992-1363