Provider Demographics
NPI:1952485203
Name:DIAMOND SCOOTERS, INC.
Entity Type:Organization
Organization Name:DIAMOND SCOOTERS, INC.
Other - Org Name:MOBILITY123
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-528-9366
Mailing Address - Street 1:645 S MILL RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201-4802
Mailing Address - Country:US
Mailing Address - Phone:856-528-9366
Mailing Address - Fax:609-646-4447
Practice Address - Street 1:645 S MILL RD STE 1
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-4802
Practice Address - Country:US
Practice Address - Phone:856-528-9366
Practice Address - Fax:609-646-4447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0024791Medicaid
NJ4908830001Medicare ID - Type Unspecified