Provider Demographics
NPI:1881955375
Name:JERSEY SHORE DME
Entity type:Organization
Organization Name:JERSEY SHORE DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIEK
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:609-312-1475
Mailing Address - Street 1:353 LEEWARD RD
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-5123
Mailing Address - Country:US
Mailing Address - Phone:609-312-1475
Mailing Address - Fax:609-698-3265
Practice Address - Street 1:353 LEEWARD RD
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-5123
Practice Address - Country:US
Practice Address - Phone:609-312-1475
Practice Address - Fax:609-698-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier