Provider Demographics
NPI:1093772675
Name:LUEL CORP
Entity Type:Organization
Organization Name:LUEL CORP
Other - Org Name:FAMILY MEDICAL AND SURGICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:DECRESCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-433-5720
Mailing Address - Street 1:671 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3337
Mailing Address - Country:US
Mailing Address - Phone:201-433-5720
Mailing Address - Fax:201-433-7453
Practice Address - Street 1:671 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3337
Practice Address - Country:US
Practice Address - Phone:201-433-5720
Practice Address - Fax:201-433-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2713101Medicaid
NJ0330640001Medicare ID - Type UnspecifiedPROVIDER NUMBER