Healthcare Provider Details

I. General information

NPI: 1831174259
Provider Name (Legal Business Name): HEALTH SUPPORT MEDIC SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7608 18TH AVE HEALTH SUPPORT MEDICAL SUPPLY INC
BROOKLYN NY
11214
US

IV. Provider business mailing address

PO BOX 1400003 HEALTH SUPPORT MEDICAL SUPPLY INC
BROOKLYN NY
11214-0003
US

V. Phone/Fax

Practice location:
  • Phone: 718-621-6090
  • Fax: 718-621-6092
Mailing address:
  • Phone: 718-621-6090
  • Fax: 718-621-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ORKHAN YUSUFOV
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 917-478-0410