Provider Demographics
NPI:1144352311
Name:GARDEN STATE SUPPLY
Entity type:Organization
Organization Name:GARDEN STATE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:848-448-2302
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-0084
Mailing Address - Country:US
Mailing Address - Phone:732-657-9600
Mailing Address - Fax:732-657-9400
Practice Address - Street 1:24 UNION AVENUE
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733-0084
Practice Address - Country:US
Practice Address - Phone:732-657-9600
Practice Address - Fax:732-657-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1107370001Medicare ID - Type Unspecified