Healthcare Provider Details

I. General information

NPI: 1093716334
Provider Name (Legal Business Name): WHITE AID MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

674 MYRTLE AVE
BROOKLYN NY
11205
US

IV. Provider business mailing address

674 MYRTLE AVE
BROOKLYN NY
11205-3950
US

V. Phone/Fax

Practice location:
  • Phone: 718-852-8222
  • Fax: 718-232-3243
Mailing address:
  • Phone: 718-852-8222
  • Fax: 718-232-3243

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 Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL GUTMAN
Title or Position: CEO
Credential:
Phone: 718-852-8222