MEDICARE: PROMEDICAL EQUIPMENT SUP LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932118882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMEDICAL EQUIPMENT SUP LLC

Provider Business Mailing Address
First Line	:	1064 CLINTON AVE
Second Line	:	SUITE 130
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3549
Country	:	US
Telephone Number	:	973-374-4400
Fax Number	:	973-374-7400

Provider Business Practice Location Address
First Line	:	1064 CLINTON AVE
Second Line	:	SUITE 130
City	:	IRVINGTON
State	:	NJ
Zip	:	07111-3549
Country	:	US
Telephone Number	:	973-374-4400
Fax Number	:	973-374-7400

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	AUGUSTUS K EJERE
Credential	:
Telephone Number	:	973-374-4400

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	08/22/2020

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Directions to “PROMEDICAL EQUIPMENT SUP LLC ” Practice Location

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