Healthcare Provider Details

I. General information

NPI: 1871553875
Provider Name (Legal Business Name): JERSEY CITY MEDICAL SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BALDWIN AVE STE 2
JERSEY CITY NJ
07306-1675
US

IV. Provider business mailing address

418 BALDWIN AVE STE 2
JERSEY CITY NJ
07306-1675
US

V. Phone/Fax

Practice location:
  • Phone: 201-217-9950
  • Fax: 201-217-9952
Mailing address:
  • Phone: 201-217-9950
  • Fax: 201-217-9952

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number45PD00000800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number45PO00012000
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ISAAC T SANTIAGO
Title or Position: PRESIDENT
Credential:
Phone: 201-217-9950