MEDICARE: ALPINE MEDICAL & SURGICAL SUPPLIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5104680001	OTHER	NJ	MEDIARE PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316029127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPINE MEDICAL & SURGICAL SUPPLIE

Provider Business Mailing Address
First Line	:	415 STATE ROUTE 18 UNIT 3
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2305
Country	:	US
Telephone Number	:	732-698-1110
Fax Number	:	732-698-1130

Provider Business Practice Location Address
First Line	:	415 STATE ROUTE 18 UNIT 3
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2305
Country	:	US
Telephone Number	:	732-698-1110
Fax Number	:	732-698-1130

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. IGOR KISIN
Credential	:
Telephone Number	:	732-698-1110

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	07/21/2022

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Directions to “ALPINE MEDICAL & SURGICAL SUPPLIE ” Practice Location

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