Healthcare Provider Details

I. General information

NPI: 1902309644
Provider Name (Legal Business Name): PRIME HEALTH MEDICAL SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8916 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-7857
US

IV. Provider business mailing address

8916 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-7857
US

V. Phone/Fax

Practice location:
  • Phone: 718-446-2300
  • Fax: 718-446-2303
Mailing address:
  • Phone: 718-446-2300
  • Fax: 718-446-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: ELLA ABUBAKAR
Title or Position: OPS MRG
Credential:
Phone: 718-446-2300