Provider Demographics
NPI:1699034801
Name:ATLANTIC SURGICAL SUPPLY CORPORATION
Entity Type:Organization
Organization Name:ATLANTIC SURGICAL SUPPLY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:AKHTAR
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-310-1530
Mailing Address - Street 1:591 SUMMIT AVE STE 619
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2709
Mailing Address - Country:US
Mailing Address - Phone:201-310-1530
Mailing Address - Fax:201-433-0757
Practice Address - Street 1:591 SUMMIT AVE STE 619
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2709
Practice Address - Country:US
Practice Address - Phone:201-310-1530
Practice Address - Fax:201-433-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0400489660332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies