Healthcare Provider Details

I. General information

NPI: 1235043068
Provider Name (Legal Business Name): PREFAB REHAB EQUIPMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8331 168TH PL
JAMAICA NY
11432-1912
US

IV. Provider business mailing address

8331 168TH PL
JAMAICA NY
11432-1912
US

V. Phone/Fax

Practice location:
  • Phone: 646-481-2542
  • Fax:
Mailing address:
  • Phone: 646-481-2542
  • 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: ANDREW KASOUTO
Title or Position: OWNER
Credential:
Phone: 646-481-2542