Provider Demographics
NPI:1831187186
Name:LIFE MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:LIFE MEDICAL SUPPLIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-925-7691
Mailing Address - Street 1:PO BOX 4087
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-8087
Mailing Address - Country:US
Mailing Address - Phone:908-925-7691
Mailing Address - Fax:908-925-1902
Practice Address - Street 1:631 E. ELIZABETH AVENUE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2661
Practice Address - Country:US
Practice Address - Phone:908-925-7691
Practice Address - Fax:908-925-1902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5165008Medicaid
NY01400797Medicaid
NJ0545410001Medicare ID - Type UnspecifiedPROVIDER NUMBER
0545410001Medicare UPIN