Provider Demographics
NPI:1144415910
Name:VALDES MEDICAL SUPPLIES LIMITED
Entity Type:Organization
Organization Name:VALDES MEDICAL SUPPLIES LIMITED
Other - Org Name:VALDES MEDICAL SUPPLIES LIMITED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-330-1926
Mailing Address - Street 1:4911 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-5510
Mailing Address - Country:US
Mailing Address - Phone:201-330-1926
Mailing Address - Fax:201-348-2270
Practice Address - Street 1:4911 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-330-1926
Practice Address - Fax:201-348-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RS00672200332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6058210001Medicare NSC