Healthcare Provider Details

I. General information

NPI: 1134056609
Provider Name (Legal Business Name): SOUTH BEACH MEDICAL SUPPLIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N STATE ROAD 7 STE 2
MARGATE FL
33063-5747
US

IV. Provider business mailing address

5 PARK CENTER CT STE 200
OWINGS MILLS MD
21117-4202
US

V. Phone/Fax

Practice location:
  • Phone: 410-358-2518
  • Fax:
Mailing address:
  • Phone: 443-341-2098
  • Fax: 410-358-0093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: ROMAN Y BALAKIRSKY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 410-358-2518