Provider Demographics
NPI:1780341560
Name:JOURNAL SQUARE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:JOURNAL SQUARE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO
Authorized Official - Prefix:
Authorized Official - First Name:MADHAT
Authorized Official - Middle Name:AMIN
Authorized Official - Last Name:S
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:551-232-7778
Mailing Address - Street 1:879A BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:879A BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4405
Practice Address - Country:US
Practice Address - Phone:201-471-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies