Provider Demographics
NPI:1225098965
Name:WEST NEW YORK MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:WEST NEW YORK MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:201-854-9910
Mailing Address - Street 1:444 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-2200
Mailing Address - Country:US
Mailing Address - Phone:201-854-9910
Mailing Address - Fax:201-854-9920
Practice Address - Street 1:444 60TH ST
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2200
Practice Address - Country:US
Practice Address - Phone:201-854-9910
Practice Address - Fax:201-854-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2437728OtherAETNA
NJ0130095Medicaid
NJ1125704OtherHORIZON NJ HEALTH
NJ2437728OtherAETNA