Provider Demographics
NPI:1194060707
Name:MEDICAL BIOTICS LLC
Entity type:Organization
Organization Name:MEDICAL BIOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MINICUCCI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:201-226-9104
Mailing Address - Street 1:218 STATE RT 17 N STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3336
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:218 STATE RT 17 N STE 400
Practice Address - Street 2:
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3336
Practice Address - Country:US
Practice Address - Phone:201-226-9104
Practice Address - Fax:201-587-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies