Provider Demographics
NPI:1770133647
Name:LJ MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:LJ MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:OCHRIMENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-757-5942
Mailing Address - Street 1:4400 N FEDERAL HWY STE 210-24
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-5187
Mailing Address - Country:US
Mailing Address - Phone:561-757-5942
Mailing Address - Fax:
Practice Address - Street 1:4400 N FEDERAL HWY STE 210-24
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-5187
Practice Address - Country:US
Practice Address - Phone:561-757-5942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-12
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies