Provider Demographics
NPI:1033278288
Name:MEDTEC MEDICAL SUPPLY, LLC
Entity type:Organization
Organization Name:MEDTEC MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-842-8220
Mailing Address - Street 1:623 RIVER RD
Mailing Address - Street 2:SUITE 1R
Mailing Address - City:FAIR HAVEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07704-3267
Mailing Address - Country:US
Mailing Address - Phone:732-842-8220
Mailing Address - Fax:732-842-8221
Practice Address - Street 1:623 RIVER RD
Practice Address - Street 2:SUITE 1R
Practice Address - City:FAIR HAVEN
Practice Address - State:NJ
Practice Address - Zip Code:07704-3267
Practice Address - Country:US
Practice Address - Phone:732-842-8220
Practice Address - Fax:732-842-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5650950001Medicare ID - Type Unspecified