=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104052703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORSUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2009
-----------------------------------------------------
Last Update Date | 01/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 32 GROVE ST
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07202-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-353-3282
-----------------------------------------------------
Fax | 908-355-5379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 GROVE ST
-----------------------------------------------------
City | ELIZABETH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07202-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-353-3282
-----------------------------------------------------
Fax | 908-355-5379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AAKASH DHERI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-353-3282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 28RS00705800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------