Healthcare Provider Details

I. General information

NPI: 1780451682
Provider Name (Legal Business Name): RV MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12202 20TH AVE
COLLEGE POINT NY
11356-2212
US

IV. Provider business mailing address

12202 20TH AVE
COLLEGE POINT NY
11356-2212
US

V. Phone/Fax

Practice location:
  • Phone: 347-368-6589
  • Fax: 347-368-6401
Mailing address:
  • Phone: 347-368-6589
  • Fax: 347-368-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROMAN COHEN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 347-951-8873