PRO MEDICAL EAST LLC

Provider Demographics

• NPI: 1841291200
• Name: PRO MEDICAL EAST LLC
• Entity type: Organization
• Organization Name: PRO MEDICAL EAST LLC
• Authorized Official - Title/Position: BUSINESS ADMIN
• Authorized Official - First Name: PATRICIA
• Authorized Official - Middle Name: ANN
• Authorized Official - Last Name: MOODY
• Authorized Official - Phone: 732-348-0103
• Mailing Address - Street 1: 1950 RUTGERS UNIVERSITY BLVD
• Mailing Address - City: LAKEWOOD
• Mailing Address - State: NJ
• Mailing Address - Zip Code: 08701-4537
• Mailing Address - Country: US
• Mailing Address - Phone: 732-657-9600
• Mailing Address - Fax: 732-657-9400
• Practice Address - Street 1: 1440 CONCHESTER HWY UNIT B2
• Practice Address - City: GARNET VALLEY
• Practice Address - State: PA
• Practice Address - Zip Code: 19060-2124
• Practice Address - Country: US
• Practice Address - Phone: 732-657-9600
• Practice Address - Fax: 732-657-9400
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-08-09
• Last Update Date: 2024-11-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
PA	000246014	Other	HIGHMARK BC
PA	226221	Other	ADVANTRA CARELINK
MO	625683800	Medicaid
MN	90171	Other	MINN BC/BS
VA	629315	Other	ANTHEM BC OF VIRGINIA
PA	P2723785	Other	AETNA
PA	1861130	Medicaid
MN	642648400	Medicaid
	8200594	Other	EVERCARE
KY	90003799	Medicaid
MI	4344350	Medicaid
CO	54432383	Medicaid
SC	DM1174	Medicaid
VA	010145988	Medicaid
	246014	Other	HIGHMARK BC/BS
WI	41731600	Medicaid
NJ	5164	Other	AMERIHEALTH
NJ	8704805	Medicaid
PA	0005164000	Other	IBX
MO	1163297	Other	MERCY HEALTH PLANS - MO
OH	2272955	Medicaid
MI	540H104220	Other	MICHIGAN BC/BS
	P2723785	Other	AETNA
OH	2272955	Medicaid
MO	625683800	Medicaid
MI	4344350	Medicaid