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General NPI Number Information
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NPI Number | 1780005801
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Entity Type | Organization
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Legal Business Name | BACK PAIN HOME SUPPLIES
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Dates
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Enumeration Date | 12/16/2013
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Last Update Date | 04/16/2014
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Provider Practice Location Address
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Address Line | 1133 E CHESTNUT AVE BLDG 2
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City | VINELAND
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State | NJ
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Zip | 08360-5001
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Country | US
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Telephone | 856-691-0482
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Fax | 856-690-8822
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Provider Business Mailing Address
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Address Line | 1133 E CHESTNUT AVE BLDG 2
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City | VINELAND
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State | NJ
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Zip | 08360-5001
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Country | US
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Telephone | 856-691-0482
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Fax | 856-690-8822
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Authorized Official
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Title or Position | OWNER
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Name | JULIE MARQUEZ
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Credential |
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Telephone | 856-691-0482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0400601424
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License Number State | NJ
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