Healthcare Provider Details

I. General information

NPI: 1811825334
Provider Name (Legal Business Name): EVERGREEN MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 COTTONWOOD LN APT B
OLD BRIDGE NJ
08857-4714
US

IV. Provider business mailing address

9 COTTONWOOD LN APT B
OLD BRIDGE NJ
08857-4714
US

V. Phone/Fax

Practice location:
  • Phone: 347-217-5952
  • Fax:
Mailing address:
  • Phone: 347-217-5952
  • 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: EBADIT LATIF
Title or Position: OWNER
Credential:
Phone: 347-217-5952