Provider Demographics
NPI:1316128671
Name:TRINITY MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:TRINITY MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-396-2306
Mailing Address - Street 1:22 VREDENBURGH AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2131
Mailing Address - Country:US
Mailing Address - Phone:973-396-2306
Mailing Address - Fax:973-396-2637
Practice Address - Street 1:22 VREDENBURGH AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-2131
Practice Address - Country:US
Practice Address - Phone:973-396-2306
Practice Address - Fax:973-396-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071025000993332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5736310001Medicare NSC