Provider Demographics
NPI:1891851192
Name:SILVER LAKE DRUG INC
Entity Type:Organization
Organization Name:SILVER LAKE DRUG INC
Other - Org Name:DAVIS SURGICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:REBARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-444-2444
Mailing Address - Street 1:577 GOFFLE RD
Mailing Address - Street 2:
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-444-2444
Mailing Address - Fax:
Practice Address - Street 1:577 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2946
Practice Address - Country:US
Practice Address - Phone:201-444-2444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0268870001Medicare NSC