Healthcare Provider Details

I. General information

NPI: 1114857356
Provider Name (Legal Business Name): EXPO MEDICAL SUPPLY CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 BROADWAY STE 1
HEWLETT NY
11557-1427
US

IV. Provider business mailing address

1553 BROADWAY STE 1
HEWLETT NY
11557-1427
US

V. Phone/Fax

Practice location:
  • Phone: 212-480-0710
  • Fax:
Mailing address:
  • Phone: 212-480-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN MORDURHAYEV
Title or Position: OWNER
Credential:
Phone: 212-480-0710