Provider Demographics
NPI:1609877992
Name:LINCOLN MEDICAL SUPPLY CO., LLC
Entity Type:Organization
Organization Name:LINCOLN MEDICAL SUPPLY CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RESES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:609-641-4050
Mailing Address - Street 1:913 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-1401
Mailing Address - Country:US
Mailing Address - Phone:609-641-4050
Mailing Address - Fax:609-641-7650
Practice Address - Street 1:913 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-1401
Practice Address - Country:US
Practice Address - Phone:609-641-4050
Practice Address - Fax:609-641-7650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8553904Medicaid
NJ4038340001Medicare NSC