Provider Demographics
NPI:1689607848
Name:ADVANCE MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KATONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-646-8955
Mailing Address - Street 1:12 LEGION PLACE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-646-8955
Mailing Address - Fax:973-646-8954
Practice Address - Street 1:12 LEGION PLACE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-646-8955
Practice Address - Fax:973-646-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9046801Medicaid
4599520001Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID