Healthcare Provider Details

I. General information

NPI: 1104070036
Provider Name (Legal Business Name): NEWBRIDGE SURGICAL SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 LAKELAND AVE
BOHEMIA NY
11716-3305
US

IV. Provider business mailing address

18227 AMMI TRL
HOUSTON TX
77060-1116
US

V. Phone/Fax

Practice location:
  • Phone: 516-349-4520
  • Fax: 516-349-4549
Mailing address:
  • Phone: 281-448-7299
  • Fax: 281-209-8025

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT KALTRIDER
Title or Position: PRESIDENT
Credential:
Phone: 203-837-2436