Provider Demographics
NPI:1528437506
Name:COMMUNITY SURGICAL SUPPLY OF TOMS RIVER LLC
Entity type:Organization
Organization Name:COMMUNITY SURGICAL SUPPLY OF TOMS RIVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSALESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-246-9499
Mailing Address - Street 1:220 W GERMANTOWN PIKE STE 250
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1437
Mailing Address - Country:US
Mailing Address - Phone:610-424-4515
Mailing Address - Fax:
Practice Address - Street 1:83 VERMONT AVE
Practice Address - Street 2:UNIT 5
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-3054
Practice Address - Country:US
Practice Address - Phone:800-349-2990
Practice Address - Fax:732-244-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier