Healthcare Provider Details

I. General information

NPI: 1639850605
Provider Name (Legal Business Name): EXCELLENT MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 11/25/2023
Certification Date: 11/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 16TH AVE
BROOKLYN NY
11204-1102
US

IV. Provider business mailing address

4503 16TH AVE
BROOKLYN NY
11204-1102
US

V. Phone/Fax

Practice location:
  • Phone: 718-247-8531
  • Fax: 718-247-8535
Mailing address:
  • Phone: 718-247-8531
  • Fax: 718-247-8535

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. SAMUEL Z SRULOWITZ
Title or Position: PRESIDENT
Credential:
Phone: 718-247-8531