Basic Information
| Provider Information | |||||||||
| NPI: | 1144284209 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY SURGICAL SUPPLY OF TOMS RIVER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 W GERMANTOWN PIKE STE 250 | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106306357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1390 ROUTE 37 W | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087554924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323492990 | ||||||||
| FaxNumber: | 7322447588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 06/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | GRIGGS | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6106306357 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 06/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3336H0001X | 28RS00625900 | NJ | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336H0001X | 028081 | NY | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336H0001X | PCN.0000981 | CT | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336H0001X | A9-0000757 | DE | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 3336H0001X | 02-1849200 | OH | N | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BP3500X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition | 332BX2000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Oxygen Equipment & Supplies |
ID Information
| ID | Type | State | Issuer | Description | 02705613 | 05 | NY | MEDICAID | 0073474 | 05 | NJ | MEDICAID | 0073491 | 05 | NJ | MEDICAID |