Provider Demographics
NPI:1518964956
Name:MAROSA SURGICAL INDUSTRIES INC
Entity Type:Organization
Organization Name:MAROSA SURGICAL INDUSTRIES INC
Other - Org Name:AVENUE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:CRTS, ATS
Authorized Official - Phone:302-674-0907
Mailing Address - Street 1:1277 S GOVERNORS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-4801
Mailing Address - Country:US
Mailing Address - Phone:302-674-0907
Mailing Address - Fax:302-674-1421
Practice Address - Street 1:1277 S GOVERNORS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4801
Practice Address - Country:US
Practice Address - Phone:302-674-0907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000062816Medicaid
DE0000062816Medicaid