Provider Demographics
NPI:1235789173
Name:DIVINE HEALTH MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:DIVINE HEALTH MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-900-5920
Mailing Address - Street 1:PO BOX 3156
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103-0156
Mailing Address - Country:US
Mailing Address - Phone:973-518-1009
Mailing Address - Fax:973-900-5921
Practice Address - Street 1:377 SMITH ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3923
Practice Address - Country:US
Practice Address - Phone:732-661-6216
Practice Address - Fax:732-934-5539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE HEALTH MEDICAL SUPPLIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies