Healthcare Provider Details

I. General information

NPI: 1831046119
Provider Name (Legal Business Name): JR SPORTING GOODS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24736 JERICHO TPKE
FLORAL PARK NY
11001-4001
US

IV. Provider business mailing address

24736 JERICHO TPKE
FLORAL PARK NY
11001-4001
US

V. Phone/Fax

Practice location:
  • Phone: 786-827-0942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. SANJEEV KUMAR RAHULL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 786-827-0942