Organization
SELFCARE MEDIQUIP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK VILLARI (PRESIDENT/CEO)
(609) 704-9211
Entity
Organization
Contact information
Practice address
8 W END AVE, HAMMONTON, NJ 08037-1539
(609) 704-9211
(609) 704-0119
Mailing address
8 W END AVE, HAMMONTON, NJ 08037-1539
(609) 704-9211
(609) 704-0119
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002631
AMERIHEALTH
—
05
—
5342309
—
NJ
01
—
92261
AMERIGROUP
—
01
—
AT000009300
AMERICHOICE
NJ
Enumeration date
04/03/2006
Last updated
04/12/2010
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