Provider Demographics
NPI:1760717979
Name:ABBA MEDICAL SUPPLIES CORPORATION
Entity Type:Organization
Organization Name:ABBA MEDICAL SUPPLIES CORPORATION
Other - Org Name:ABBA CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AKINOLA
Authorized Official - Middle Name:HANSON
Authorized Official - Last Name:ADEJUWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-723-0055
Mailing Address - Street 1:3629 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-5104
Mailing Address - Country:US
Mailing Address - Phone:302-478-5294
Mailing Address - Fax:302-478-1548
Practice Address - Street 1:3629 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-5104
Practice Address - Country:US
Practice Address - Phone:302-478-5294
Practice Address - Fax:302-478-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2005207031332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4410300001Medicare NSC