MEDICARE: SILVERCARE CUSTOM WHEELCHAIR SPECIALIST

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1720503386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVERCARE CUSTOM WHEELCHAIR SPECIALIST

Provider Business Mailing Address
First Line	:	4 MCKINLEY AVE
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-2377
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 E COUNTY LINE RD
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-1426
Country	:	US
Telephone Number	:	732-276-5828
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	AVROHOM ELLINSON
Credential	:	ATP
Telephone Number	:	732-276-5828

Provider Enumeration Date	:	08/04/2017
Last Update Date	:	12/20/2022

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