Provider Demographics
NPI:1073701207
Name:ELDERKARE MEDICAL SUPPLIES LLC.
Entity Type:Organization
Organization Name:ELDERKARE MEDICAL SUPPLIES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MURIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-751-5625
Mailing Address - Street 1:1311 SUMMIT AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6250
Mailing Address - Country:US
Mailing Address - Phone:201-751-5625
Mailing Address - Fax:201-751-5627
Practice Address - Street 1:1311 SUMMIT AVE
Practice Address - Street 2:SUITE
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6250
Practice Address - Country:US
Practice Address - Phone:201-751-5625
Practice Address - Fax:201-751-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0600310796332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6020000001Medicare NSC