Provider Demographics
NPI:1851919914
Name:ACTIVE SENIOR MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ACTIVE SENIOR MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:201-244-8908
Mailing Address - Street 1:223 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-2919
Mailing Address - Country:US
Mailing Address - Phone:201-244-8908
Mailing Address - Fax:201-244-8907
Practice Address - Street 1:223 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-2919
Practice Address - Country:US
Practice Address - Phone:201-244-8908
Practice Address - Fax:201-244-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies