Provider Demographics
NPI:1659768372
Name:COMMUNITY SURGICAL SUPPLY OF TOMS RIVER, INC.
Entity Type:Organization
Organization Name:COMMUNITY SURGICAL SUPPLY OF TOMS RIVER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-349-2990
Mailing Address - Street 1:PO BOX 4686
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-4686
Mailing Address - Country:US
Mailing Address - Phone:800-349-2990
Mailing Address - Fax:732-244-7588
Practice Address - Street 1:98 TEC ST UNIT B
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3655
Practice Address - Country:US
Practice Address - Phone:800-349-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02838993Medicaid
NY02838993Medicaid