Healthcare Provider Details

I. General information

NPI: 1750219333
Provider Name (Legal Business Name): ROUTE 99 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 CHESTNUT ST APT 2
RIDGEWOOD NJ
07450-2570
US

IV. Provider business mailing address

89 CHESTNUT ST APT 2
RIDGEWOOD NJ
07450-2570
US

V. Phone/Fax

Practice location:
  • Phone: 201-483-1471
  • Fax:
Mailing address:
  • Phone: 201-483-1471
  • 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: VINCENT MATTHEWS
Title or Position: SOLE MEMBER
Credential:
Phone: 201-483-1471