Provider Demographics
NPI:1043353212
Name:DIRECT DIABETIC SUPPLY LLC
Entity Type:Organization
Organization Name:DIRECT DIABETIC SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WASSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-251-6503
Mailing Address - Street 1:7040 W PALMETTO PARK RD
Mailing Address - Street 2:BLDG 4 SUITE 464
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3407
Mailing Address - Country:US
Mailing Address - Phone:561-251-6503
Mailing Address - Fax:561-998-8807
Practice Address - Street 1:7040 W PALMETTO PARK RD
Practice Address - Street 2:BLDG 4 SUITE 464
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3407
Practice Address - Country:US
Practice Address - Phone:561-251-6503
Practice Address - Fax:561-998-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies