Healthcare Provider Details

I. General information

NPI: 1720503386
Provider Name (Legal Business Name): SILVERCARE CUSTOM WHEELCHAIR SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 E COUNTY LINE RD
LAKEWOOD NJ
08701-1426
US

IV. Provider business mailing address

4 MCKINLEY AVE
LAKEWOOD NJ
08701-2377
US

V. Phone/Fax

Practice location:
  • Phone: 732-276-5828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: AVROHOM ELLINSON
Title or Position: OWNER
Credential: ATP
Phone: 732-276-5828