Provider Demographics
NPI:1578665816
Name:ISECO INC
Entity Type:Organization
Organization Name:ISECO INC
Other - Org Name:ATLANTIC MEDICAL SUPPLIES & HEALTHCARE EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IME
Authorized Official - Middle Name:S
Authorized Official - Last Name:ESHIET
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:609-345-4040
Mailing Address - Street 1:PO BOX 8007
Mailing Address - Street 2:ATLANTIC MEDICAL SUPPLIES & HEALTHCARE EQUIPMENT
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401
Mailing Address - Country:US
Mailing Address - Phone:609-345-4040
Mailing Address - Fax:609-345-2424
Practice Address - Street 1:1300 ATLANTIC AVE
Practice Address - Street 2:CITICENTER BUILDING SUITE 102
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-345-4040
Practice Address - Fax:609-345-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5003028332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024139Medicaid
4774160001Medicare ID - Type Unspecified