Provider Demographics
NPI:1205976610
Name:AAA MEDICAL DEPOT LLC
Entity type:Organization
Organization Name:AAA MEDICAL DEPOT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:AMATO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:732-272-4867
Mailing Address - Street 1:309 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6515
Mailing Address - Country:US
Mailing Address - Phone:877-222-6331
Mailing Address - Fax:
Practice Address - Street 1:309 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6515
Practice Address - Country:US
Practice Address - Phone:877-222-6331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5003418332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5894430001Medicare NSC