Healthcare Provider Details

I. General information

NPI: 1417998345
Provider Name (Legal Business Name): B.W. SURGICAL SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/03/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10556 METROPOLITAN AVE
KENSINGTON MD
20895-2606
US

IV. Provider business mailing address

10556 METROPOLITAN AVE
KENSINGTON MD
20895-2606
US

V. Phone/Fax

Practice location:
  • Phone: 301-946-1888
  • Fax: 301-946-4479
Mailing address:
  • Phone: 301-946-1888
  • Fax: 301-946-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. YAN FELDBLYUM
Title or Position: PRESIDENT
Credential:
Phone: 301-946-1888