Organization
I.D.M. MEDICAL SUPPLY CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT GONNELLO (GENERAL MANAGER)
(201) 445-8500
Entity
Organization
Contact information
Practice address
620 BRAEN AVE, WYCKOFF, NJ 07481-2914
(201) 445-8500
(201) 445-2274
Mailing address
620 BRAEN AVE, WYCKOFF, NJ 07481-2914
(201) 445-8500
(201) 445-2274
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0691822
NJ
Other
Enumeration date
05/23/2008
Last updated
07/18/2008
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