Provider Demographics
NPI:1093884116
Name:SUNRISE SURGICAL & MEDICAL SUPPLIES,LLC
Entity Type:Organization
Organization Name:SUNRISE SURGICAL & MEDICAL SUPPLIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-364-3756
Mailing Address - Street 1:516 NEW FRIENDSHIP RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2978
Mailing Address - Country:US
Mailing Address - Phone:732-901-9500
Mailing Address - Fax:732-901-9522
Practice Address - Street 1:516 NEW FRIENDSHIP RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2978
Practice Address - Country:US
Practice Address - Phone:732-901-9500
Practice Address - Fax:732-901-9522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5822390001Medicare NSC