Provider Demographics
NPI:1073071072
Name:PHOENIX MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:PHOENIX MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-617-8387
Mailing Address - Street 1:29 S NEW YORK RD STE 900
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9697
Mailing Address - Country:US
Mailing Address - Phone:609-617-8387
Mailing Address - Fax:
Practice Address - Street 1:29 S NEW YORK RD STE 900
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9697
Practice Address - Country:US
Practice Address - Phone:609-617-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies