Provider Demographics
NPI:1235389768
Name:NEW AGE MEDICAL, LLC
Entity Type:Organization
Organization Name:NEW AGE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARMUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-518-9998
Mailing Address - Street 1:55 BUCK RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-1501
Mailing Address - Country:US
Mailing Address - Phone:215-518-9998
Mailing Address - Fax:215-396-6650
Practice Address - Street 1:55 BUCK RD
Practice Address - Street 2:SUITE 11
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-1501
Practice Address - Country:US
Practice Address - Phone:215-518-9998
Practice Address - Fax:215-396-6650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-20
Last Update Date:2008-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier