Provider Demographics
NPI:1295862019
Name:SOUTH ORANGE MEDICAL SUPPLIES CORP
Entity Type:Organization
Organization Name:SOUTH ORANGE MEDICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HEINRICH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIGIRINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-763-7869
Mailing Address - Street 1:310 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2502
Mailing Address - Country:US
Mailing Address - Phone:973-763-7869
Mailing Address - Fax:973-763-3502
Practice Address - Street 1:310 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-2502
Practice Address - Country:US
Practice Address - Phone:973-763-7869
Practice Address - Fax:973-763-3502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ85766Medicaid
NJ85766Medicaid