MEDICARE: I & J SUPPLIES 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1922202316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I & J SUPPLIES INC

Provider Business Mailing Address
First Line	:	5377 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6704
Country	:	US
Telephone Number	:	718-451-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5377 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-6704
Country	:	US
Telephone Number	:	718-451-1010
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ISRAEL NEIMAN
Credential	:
Telephone Number	:	719-451-1010

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	03/23/2009

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