Healthcare Provider Details

I. General information

NPI: 1396261426
Provider Name (Legal Business Name): TRIPLE A SUPPLIES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 JEANNE DRIVE
NEWBURGH NY
12550-7634
US

IV. Provider business mailing address

50 JEANNE DRIVE
NEWBURGH NY
12550-7634
US

V. Phone/Fax

Practice location:
  • Phone: 845-926-3340
  • Fax: 845-926-3347
Mailing address:
  • Phone: 845-926-3340
  • Fax: 945-926-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MS. TONJA ALEXANDRA WERKMAN
Title or Position: VICE PRESIDENT
Credential: MS, R.D.N
Phone: 732-267-0490