Provider Demographics
NPI:1679593446
Name:OJ MEDTECH, INC
Entity Type:Organization
Organization Name:OJ MEDTECH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:TALLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-829-9813
Mailing Address - Street 1:200 CARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-1222
Mailing Address - Country:US
Mailing Address - Phone:631-666-5000
Mailing Address - Fax:631-666-5444
Practice Address - Street 1:200 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-1222
Practice Address - Country:US
Practice Address - Phone:631-666-5000
Practice Address - Fax:631-666-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03288144Medicaid
NY1249260001OtherSUPPLIER NUMBER