Organization
PRO MEDICAL EAST LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA ANN MOODY (BUSINESS ADMIN)
(732) 348-0103
Entity
Organization
Contact information
Practice address
1440 CONCHESTER HWY UNIT B2, GARNET VALLEY, PA 19060-2124
(732) 657-9600
(732) 657-9400
Mailing address
1950 RUTGERS UNIVERSITY BLVD, LAKEWOOD, NJ 08701-4537
(732) 657-9600
(732) 657-9400
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000246014
HIGHMARK BC
PA
01
—
0005164000
IBX
PA
05
—
010145988
—
VA
01
—
1163297
MERCY HEALTH PLANS - MO
MO
05
—
1861130
—
PA
01
—
226221
ADVANTRA CARELINK
PA
05
—
2272955
—
OH
01
—
246014
HIGHMARK BC/BS
—
05
—
41731600
—
WI
05
—
4344350
—
MI
01
—
5164
AMERIHEALTH
NJ
01
—
540H104220
MICHIGAN BC/BS
MI
05
—
54432383
—
CO
05
—
625683800
—
MO
01
—
629315
ANTHEM BC OF VIRGINIA
VA
05
—
642648400
—
MN
01
—
8200594
EVERCARE
—
05
—
8704805
—
NJ
05
—
90003799
—
KY
01
—
90171
MINN BC/BS
MN
05
—
DM1174
—
SC
01
—
P2723785
AETNA
PA
01
—
P2723785
AETNA
—
Enumeration date
08/09/2005
Last updated
11/07/2024
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