Healthcare Provider Details

I. General information

NPI: 1366390825
Provider Name (Legal Business Name): XYZ MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6735 YELLOWSTONE BLVD APT 6F
FOREST HILLS NY
11375-2605
US

IV. Provider business mailing address

6735 YELLOWSTONE BLVD APT 6F
FOREST HILLS NY
11375-2605
US

V. Phone/Fax

Practice location:
  • Phone: 516-529-1094
  • Fax:
Mailing address:
  • Phone: 516-529-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DANIEL SHIF
Title or Position: OWNER
Credential:
Phone: 646-256-7096