MEDICARE: AVENZA SUPPLY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1114859527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVENZA SUPPLY INC

Provider Business Mailing Address
First Line	:	1659 W 4TH ST # 2F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1541
Country	:	US
Telephone Number	:	202-482-9058
Fax Number	:

Provider Business Practice Location Address
First Line	:	1659 W 4TH ST # 2F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1541
Country	:	US
Telephone Number	:	202-482-9058
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	AZAMAT KASIMOV
Credential	:
Telephone Number	:	202-482-9058

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “AVENZA SUPPLY INC ” Practice Location

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