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General NPI Number Information
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NPI Number | 1902855752
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Entity Type | Organization
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Legal Business Name | EQUILIBRIUM MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 301
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-455-2190
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Fax | 954-455-5997
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Provider Business Mailing Address
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Address Line | 2100 E HALLANDALE BEACH BLVD SUITE 301
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3765
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Country | US
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Telephone | 954-455-2190
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Fax | 954-455-5997
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEREMY WAXMAN
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Credential |
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Telephone | 954-455-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | PO 3232
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License Number State | FL
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