Healthcare Provider Details

I. General information

NPI: 1669616728
Provider Name (Legal Business Name): QUALITY CARE MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11551 237TH ST
ELMONT NY
11003-3924
US

IV. Provider business mailing address

11551 237TH ST
ELMONT NY
11003-3924
US

V. Phone/Fax

Practice location:
  • Phone: 191-770-1514
  • Fax: 516-612-2542
Mailing address:
  • Phone: 191-770-1514
  • Fax: 516-612-2542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1420716
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1420716
License Number StateNY

VIII. Authorized Official

Name: MR. EVANS O. ALAWURU
Title or Position: PRESIDENT
Credential:
Phone: 917-701-5143