Healthcare Provider Details

I. General information

NPI: 1629089016
Provider Name (Legal Business Name): DME CERTIFIED SUPPLIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4621 7TH AVENUE
BROOKLYN NY
11220-6520
US

IV. Provider business mailing address

4621 7TH AVENUE
BROOKLYN NY
11220-6520
US

V. Phone/Fax

Practice location:
  • Phone: 347-799-2228
  • Fax: 347-799-2234
Mailing address:
  • Phone: 347-799-2228
  • Fax: 347-799-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code224L00000X
TaxonomyPedorthist
License Number
License Number StateNULL

VIII. Authorized Official

Name: YEGOR ZADOROZHNYI
Title or Position: PRESIDENT
Credential:
Phone: 347-799-2228