Healthcare Provider Details

I. General information

NPI: 1326367004
Provider Name (Legal Business Name): JSB MENDICAL SUPPLY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2010
Last Update Date: 05/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 LESTER ST
BX NY
10467
US

IV. Provider business mailing address

654 LESTER ST
BRONX NY
10467-6706
US

V. Phone/Fax

Practice location:
  • Phone: 347-869-8228
  • Fax:
Mailing address:
  • Phone: 347-869-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JASHA S BENNETT
Title or Position: OWNER
Credential:
Phone: 347-869-8228