Healthcare Provider Details

I. General information

NPI: 1194894378
Provider Name (Legal Business Name): LONG BEACH SURGICAL SUPPLY COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 W PARK AVE
LONG BEACH NY
11561-3222
US

IV. Provider business mailing address

259 W PARK AVE
LONG BEACH NY
11561-3222
US

V. Phone/Fax

Practice location:
  • Phone: 516-431-0617
  • Fax: 516-431-0784
Mailing address:
  • Phone: 516-431-0617
  • Fax: 516-431-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS SCHONFELD
Title or Position: PRESIDENT
Credential:
Phone: 516-431-0617