Organization
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Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREGG FRANK OTRL (OWNER)
(973) 219-4147
Entity
Organization
Contact information
Practice address
5 TANGLEWOOD CT, RANDOLPH, NJ 07869-4306
(973) 366-3988
Mailing address
5 TANGLEWOOD CT, RANDOLPH, NJ 07869-4306
(973) 366-3988
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
46TR00181500
NJ
Other
Enumeration date
02/27/2007
Last updated
08/22/2020
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