Provider Demographics
NPI:1790021525
Name:MID-ATLANTIC MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:MID-ATLANTIC MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TJ
Authorized Official - Middle Name:
Authorized Official - Last Name:MESSINEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-446-5830
Mailing Address - Street 1:79 N. FRANKLIN TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RAMSEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07446
Mailing Address - Country:US
Mailing Address - Phone:201-446-5830
Mailing Address - Fax:
Practice Address - Street 1:79 N. FRANKLIN TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446
Practice Address - Country:US
Practice Address - Phone:201-446-5830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies