Healthcare Provider Details

I. General information

NPI: 1366002495
Provider Name (Legal Business Name): DYNAMIC RESPIRATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 ROUTE 46 W STE 160
FAIRFIELD NJ
07004-2459
US

IV. Provider business mailing address

612 CORPORATE WAY STE 2M
VALLEY COTTAGE NY
10989-2027
US

V. Phone/Fax

Practice location:
  • Phone: 973-222-6195
  • Fax: 718-362-1651
Mailing address:
  • Phone: 877-258-6331
  • 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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW MELNICKE
Title or Position: OWNER
Credential:
Phone: 718-362-1411