Healthcare Provider Details

I. General information

NPI: 1073460846
Provider Name (Legal Business Name): MEDIVA MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 E 147TH ST
BRONX NY
10455-4181
US

IV. Provider business mailing address

531 W 49TH ST APT 3W
NEW YORK NY
10019-7150
US

V. Phone/Fax

Practice location:
  • Phone: 732-668-5529
  • Fax:
Mailing address:
  • Phone: 732-668-5529
  • 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. PETER ABRAHAM
Title or Position: OWNER
Credential:
Phone: 732-668-5529