Provider Demographics
NPI:1811480064
Name:AU MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:AU MEDICAL SUPPLY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:USPENSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-837-9462
Mailing Address - Street 1:45 MAIN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-2327
Mailing Address - Country:US
Mailing Address - Phone:732-837-9462
Mailing Address - Fax:
Practice Address - Street 1:45 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-2327
Practice Address - Country:US
Practice Address - Phone:732-837-9462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies