Provider Demographics
NPI:1275789281
Name:ADVANCED ORTHOMEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:ADVANCED ORTHOMEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIUSZ
Authorized Official - Middle Name:P
Authorized Official - Last Name:GROMUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-855-2300
Mailing Address - Street 1:4461 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5117
Mailing Address - Country:US
Mailing Address - Phone:516-855-2300
Mailing Address - Fax:516-977-0412
Practice Address - Street 1:4461 11TH ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5117
Practice Address - Country:US
Practice Address - Phone:516-855-2300
Practice Address - Fax:516-977-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-09
Last Update Date:2008-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY915661944332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies