Healthcare Provider Details

I. General information

NPI: 1609877992
Provider Name (Legal Business Name): LINCOLN MEDICAL SUPPLY CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 N MAIN ST
PLEASANTVILLE NJ
08232-1401
US

IV. Provider business mailing address

913 N MAIN ST
PLEASANTVILLE NJ
08232-1401
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-4050
  • Fax: 609-641-7650
Mailing address:
  • Phone: 609-641-4050
  • Fax: 609-641-7650

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: MR. JEFFREY ALAN RESES
Title or Position: OWNER
Credential: R.PH
Phone: 609-641-4050