Provider Demographics
NPI:1174260509
Name:WILTON MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:WILTON MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICAL
Authorized Official - Prefix:
Authorized Official - First Name:VIKASH
Authorized Official - Middle Name:M
Authorized Official - Last Name:NEGANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-558-0922
Mailing Address - Street 1:1881 NE 26TH ST STE 237
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1426
Mailing Address - Country:US
Mailing Address - Phone:954-727-1204
Mailing Address - Fax:954-727-1204
Practice Address - Street 1:1881 NE 26TH ST STE 237
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1426
Practice Address - Country:US
Practice Address - Phone:954-727-1204
Practice Address - Fax:954-727-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies