Provider Demographics
NPI:1275259137
Name:ACTIVE MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:ACTIVE MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCAMILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-506-4055
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-0820
Mailing Address - Country:US
Mailing Address - Phone:973-506-4055
Mailing Address - Fax:973-506-6728
Practice Address - Street 1:855 VALLEY RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2441
Practice Address - Country:US
Practice Address - Phone:973-506-4055
Practice Address - Fax:973-506-6728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies