Healthcare Provider Details

I. General information

NPI: 1902283112
Provider Name (Legal Business Name): MSK MAVRX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 S SERVICE RD STE 210A
MELVILLE NY
11747-2335
US

IV. Provider business mailing address

48 S SERVICE RD STE 210A
MELVILLE NY
11747-2335
US

V. Phone/Fax

Practice location:
  • Phone: 631-396-0290
  • Fax:
Mailing address:
  • Phone: 631-396-0290
  • 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: MR. KENNETH ROPKE
Title or Position: OWNER
Credential:
Phone: 516-770-1973