Provider Demographics
NPI:1073364576
Name:NEW SAMPLE 33 CORP
Entity Type:Organization
Organization Name:NEW SAMPLE 33 CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ORLANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-812-1653
Mailing Address - Street 1:10191 W SAMPLE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-3903
Mailing Address - Country:US
Mailing Address - Phone:754-812-1653
Mailing Address - Fax:
Practice Address - Street 1:10191 W SAMPLE RD STE 204
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-3903
Practice Address - Country:US
Practice Address - Phone:754-812-1653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies