Provider Demographics
NPI:1023255502
Name:ALPHA MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ALPHA MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:IMANGULOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-776-3839
Mailing Address - Street 1:12 N 26TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-1114
Mailing Address - Country:US
Mailing Address - Phone:267-776-3839
Mailing Address - Fax:267-776-3838
Practice Address - Street 1:12 N 26TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-1114
Practice Address - Country:US
Practice Address - Phone:267-776-3839
Practice Address - Fax:267-776-3838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies