Healthcare Provider Details

I. General information

NPI: 1336073683
Provider Name (Legal Business Name): NEXUS GROUP SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 E 14TH ST APT 2K
BROOKLYN NY
11229-2051
US

IV. Provider business mailing address

1730 E 14TH ST APT 2K
BROOKLYN NY
11229-2051
US

V. Phone/Fax

Practice location:
  • Phone: 929-377-4188
  • Fax:
Mailing address:
  • Phone: 929-377-4188
  • 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: AZAMAT IBRAGIMOV
Title or Position: CEO
Credential:
Phone: 929-377-4133