Provider Demographics
NPI:1871642322
Name:MIDDLETOWN SURGICAL SUPPLY, INC.
Entity type:Organization
Organization Name:MIDDLETOWN SURGICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIPALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-706-9117
Mailing Address - Street 1:104 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07748-2025
Mailing Address - Country:US
Mailing Address - Phone:732-706-9117
Mailing Address - Fax:732-706-0462
Practice Address - Street 1:104 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2025
Practice Address - Country:US
Practice Address - Phone:732-706-9117
Practice Address - Fax:732-706-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8705208Medicaid
NJ4242280001Medicare ID - Type Unspecified