Healthcare Provider Details

I. General information

NPI: 1417229105
Provider Name (Legal Business Name): SEASIDE DME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 60TH ST
BROOKLYN NY
11219-4925
US

IV. Provider business mailing address

1143 60TH ST
BROOKLYN NY
11219-4925
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-7250
  • Fax: 718-343-1716
Mailing address:
  • Phone: 718-686-7250
  • Fax: 718-343-1716

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: JINGLING TANG
Title or Position: PRESIDENT
Credential:
Phone: 718-686-7250