Healthcare Provider Details

I. General information

NPI: 1568567469
Provider Name (Legal Business Name): KRIECK ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARK AVE
MADISON NJ
07940-1122
US

IV. Provider business mailing address

125 PARK AVENUE
MADISON NJ
07940-1122
US

V. Phone/Fax

Practice location:
  • Phone: 973-377-8990
  • Fax: 973-377-8995
Mailing address:
  • Phone: 973-377-8990
  • Fax: 973-377-8995

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. TOM KRIECK
Title or Position: PARTNER
Credential:
Phone: 973-377-8990