Provider Demographics
NPI:1679385041
Name:ACCIDENT INJURY SUPPLIES LLC
Entity type:Organization
Organization Name:ACCIDENT INJURY SUPPLIES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAIMUNDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-690-8883
Mailing Address - Street 1:1133 E CHESTNUT AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5054
Mailing Address - Country:US
Mailing Address - Phone:856-690-8883
Mailing Address - Fax:
Practice Address - Street 1:1133 E CHESTNUT AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5054
Practice Address - Country:US
Practice Address - Phone:856-690-8883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies