Provider Demographics
NPI:1720536139
Name:ORTHOSUPPLY, LLC
Entity Type:Organization
Organization Name:ORTHOSUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-916-8758
Mailing Address - Street 1:10 MAIN ST
Mailing Address - Street 2:UNIT 177
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-3300
Mailing Address - Country:US
Mailing Address - Phone:410-916-8758
Mailing Address - Fax:201-503-8167
Practice Address - Street 1:10 MAIN STREET UNIT 177
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095
Practice Address - Country:US
Practice Address - Phone:410-916-8758
Practice Address - Fax:201-503-8167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies