Provider Demographics
NPI:1952617466
Name:PRO MEDQUIP
Entity type:Organization
Organization Name:PRO MEDQUIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-622-2772
Mailing Address - Street 1:3601 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-6005
Mailing Address - Country:US
Mailing Address - Phone:201-766-4293
Mailing Address - Fax:201-766-4295
Practice Address - Street 1:3601 PARK AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-6005
Practice Address - Country:US
Practice Address - Phone:201-766-4293
Practice Address - Fax:201-766-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies