Healthcare Provider Details

I. General information

NPI: 1144352311
Provider Name (Legal Business Name): GARDEN STATE SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 UNION AVENUE
LAKEHURST NJ
08733-0084
US

IV. Provider business mailing address

PO BOX 84
BEACHWOOD NJ
08722-0084
US

V. Phone/Fax

Practice location:
  • Phone: 732-657-9600
  • Fax: 732-657-9400
Mailing address:
  • Phone: 732-657-9600
  • Fax: 732-657-9400

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: MS. ANNE SHARON LEO
Title or Position: OWNER
Credential:
Phone: 848-448-2302