Healthcare Provider Details

I. General information

NPI: 1699682351
Provider Name (Legal Business Name): IMAX SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2995 MARION AVE APT 4E
BRONX NY
10458-1772
US

IV. Provider business mailing address

14588 176TH ST
JAMAICA NY
11434-5230
US

V. Phone/Fax

Practice location:
  • Phone: 602-412-6091
  • Fax:
Mailing address:
  • Phone: 602-412-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SAMANA HUSSAIN
Title or Position: CEO
Credential:
Phone: 602-412-6091