Provider Demographics
NPI:1598243057
Name:ELITE MEDICAL SUPPLY
Entity type:Organization
Organization Name:ELITE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULVIRENTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-490-4614
Mailing Address - Street 1:316 BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2155
Mailing Address - Country:US
Mailing Address - Phone:732-490-4614
Mailing Address - Fax:
Practice Address - Street 1:316 BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2155
Practice Address - Country:US
Practice Address - Phone:732-490-4614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies