Healthcare Provider Details

I. General information

NPI: 1700992245
Provider Name (Legal Business Name): KINGS HWY MEDIQUIP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 E KINGS HWY SUITE 502
MAPLE SHADE NJ
08052-3424
US

IV. Provider business mailing address

122 E KINGS HWY SUITE 502
MAPLE SHADE NJ
08052-3424
US

V. Phone/Fax

Practice location:
  • Phone: 856-234-8978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. NATALIA TOLCHINSKY
Title or Position: PRESIDENT
Credential:
Phone: 856-234-8978