Provider Demographics
NPI:1801364781
Name:KYNETIC MEDICAL GROUP INC
Entity Type:Organization
Organization Name:KYNETIC MEDICAL GROUP INC
Other - Org Name:NOVA DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ARPA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-763-3877
Mailing Address - Street 1:5549 MAPLEDALE PLZ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4527
Mailing Address - Country:US
Mailing Address - Phone:703-763-3877
Mailing Address - Fax:703-763-3945
Practice Address - Street 1:5549 MAPLEDALE PLZ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4527
Practice Address - Country:US
Practice Address - Phone:703-763-3877
Practice Address - Fax:703-763-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies