Healthcare Provider Details

I. General information

NPI: 1023042348
Provider Name (Legal Business Name): MID ISLAND MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E MAIN ST
MOUNT KISCO NY
10549-2311
US

IV. Provider business mailing address

500 7TH AVE FL 8
NEW YORK NY
10018-4502
US

V. Phone/Fax

Practice location:
  • Phone: 347-503-7148
  • Fax: 347-503-7148
Mailing address:
  • Phone: 347-503-7148
  • Fax: 347-503-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: COREY DEUTSCH
Title or Position: CEO
Credential:
Phone: 845-803-4368