Provider Demographics
NPI:1962027573
Name:GARDEN STATE DME SUPPLIERS LLC
Entity type:Organization
Organization Name:GARDEN STATE DME SUPPLIERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FORZANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-522-1652
Mailing Address - Street 1:1930 HIGHWAY 35 STE 4
Mailing Address - Street 2:
Mailing Address - City:WALL TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-3538
Mailing Address - Country:US
Mailing Address - Phone:732-522-1652
Mailing Address - Fax:732-974-7964
Practice Address - Street 1:1930 HIGHWAY 35 STE 4
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3538
Practice Address - Country:US
Practice Address - Phone:732-522-1652
Practice Address - Fax:732-974-7964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies