Provider Demographics
NPI:1871553875
Name:JERSEY CITY MEDICAL SUPPLIES, INC
Entity type:Organization
Organization Name:JERSEY CITY MEDICAL SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-217-9950
Mailing Address - Street 1:418 BALDWIN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1675
Mailing Address - Country:US
Mailing Address - Phone:201-217-9950
Mailing Address - Fax:201-217-9952
Practice Address - Street 1:418 BALDWIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1675
Practice Address - Country:US
Practice Address - Phone:201-217-9950
Practice Address - Fax:201-217-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 335E00000X
NJ45PD00000800335E00000X
NJ45PO00012000335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8565601Medicaid
NJ1307150001Medicare NSC
NJ8565601Medicaid