Provider Demographics
NPI:1750796124
Name:BLACK CARD MEDICAL LLC
Entity type:Organization
Organization Name:BLACK CARD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:WECHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-406-6483
Mailing Address - Street 1:26 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-3312
Mailing Address - Country:US
Mailing Address - Phone:201-406-6483
Mailing Address - Fax:
Practice Address - Street 1:26 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3312
Practice Address - Country:US
Practice Address - Phone:201-406-6483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies