| Organization Name: | INNOVATIVE SUPPLY GROUP, LLC |
| NPI Number: | 1164756755 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SAUL GREENBERGER (PRESIDENT) |
| Mailing Address: | 200 Sheffield St Suite 105 Mountainside |
| State: | NJ US |
| Postal Code: | 070922314 |
| Phone Number: | 9083891818 |
| Fax Number: | |
| NPI Enumeration Date: | 09/29/2009 |
| NPI Last Update Date: | 07/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BP3500X |
| License Number: | 1509850 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Parenteral & Enteral Nutrition |
| Taxonomy Definition: | |