=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144833955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEDICATED MEDICAL PROVIDERS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2020
-----------------------------------------------------
Last Update Date | 02/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 WALNUT ST STE 104-C
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-975-1129
-----------------------------------------------------
Fax | 201-987-1187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 WALNUT ST STE 104-C
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07648-1335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-975-1129
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | PETER KUNTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-975-1129
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------