Provider Demographics
NPI:1104871698
Name:TGZACQUISITION CO LLC
Entity type:Organization
Organization Name:TGZACQUISITION CO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSET & COMPLIANCE MGR
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEZEEUW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-800-4276
Mailing Address - Street 1:4 HADDONFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1466
Mailing Address - Country:US
Mailing Address - Phone:800-800-4276
Mailing Address - Fax:800-236-2308
Practice Address - Street 1:4 HADDONFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1466
Practice Address - Country:US
Practice Address - Phone:800-800-4276
Practice Address - Fax:800-236-2308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NJ5002993332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4671080001Medicare ID - Type Unspecified