Provider Demographics
NPI:1396261426
Name:TRIPLE A SUPPLIES, INC
Entity type:Organization
Organization Name:TRIPLE A SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TONJA
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:WERKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN
Authorized Official - Phone:732-267-0490
Mailing Address - Street 1:50 JEANNE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7634
Mailing Address - Country:US
Mailing Address - Phone:845-926-3340
Mailing Address - Fax:945-926-3347
Practice Address - Street 1:50 JEANNE DRIVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7634
Practice Address - Country:US
Practice Address - Phone:845-926-3340
Practice Address - Fax:845-926-3347
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRIPLE A SUPPLIES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty