NPIMap

Organization Active NPI

Pro Medical East LLC

  • Durable Medical Equipment & Medical Supplies
  • Passaic, NJ
National Provider Identifier
1669124780
Registry record updated Jan 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PRO MEDICAL EAST LLC
Practice address
178 Main Ave
Passaic, NJ 07055-5403
Phone
(862) 225-3444
NPI assigned
Jan 20, 2022
Organization subpart
Yes
Parent organization
PRO MEDICAL EAST LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Patricia Ann Moody
Title
Office Manager
Phone
(732) 348-0103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

178 Main Ave
Passaic, NJ 07055-5403

Mailing address

1950 Rutgers University Blvd Ste D
Lakewood, NJ 08701-4537
Phone (732) 348-0103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220505000118 NJ DME Supplier - Certified Orth/Pros/PedorthistDME Supplier - Orthotic PersonnelDME Supplier - Prosthetic Personnel 7517179625 Practice locations: Passaic, NJ

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Healthcare Partners LLC4 organizations share this tax ID, including this one
Part of
Healthcare Partners LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3551 N Federal Hwy
#A
Boca Raton, FL 33431
Phone (855) 444-6337

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642636800000",
    "number": "1669124780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 RUTGERS UNIVERSITY BLVD STE D",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087014537",
            "telephone_number": "732-348-0103",
            "fax_number": "732-348-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "178 MAIN AVE",
            "city": "PASSAIC",
            "state": "NJ",
            "postal_code": "070555403",
            "telephone_number": "862-225-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO MEDICAL EAST LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRO MEDICAL EAST LLC",
        "enumeration_date": "2022-01-20",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A",
        "authorized_official_last_name": "MOODY",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "732-348-0103",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Passaic, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.