Provider Demographics
NPI:1376679894
Name:COOGAN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:COOGAN MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:COOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-886-2111
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:14 OAK AVE
Mailing Address - City:VILLAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08251-0004
Mailing Address - Country:US
Mailing Address - Phone:609-886-2111
Mailing Address - Fax:609-886-5668
Practice Address - Street 1:14 OAK AVE
Practice Address - Street 2:
Practice Address - City:VILLAS
Practice Address - State:NJ
Practice Address - Zip Code:08251-0004
Practice Address - Country:US
Practice Address - Phone:609-886-2111
Practice Address - Fax:609-886-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5216605Medicaid
NJ5216605Medicaid