Healthcare Provider Details

I. General information

NPI: 1780633016
Provider Name (Legal Business Name): AB SURGICAL SUPPLY CO., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 W LINCOLN AVE
MOUNT VERNON NY
10550-1243
US

IV. Provider business mailing address

238 W LINCOLN AVE
MOUNT VERNON NY
10550-1243
US

V. Phone/Fax

Practice location:
  • Phone: 914-664-9322
  • Fax:
Mailing address:
  • Phone: 914-664-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS HENRY BOUSCHE
Title or Position: CERTIFIED ORTHOTIST
Credential: CO
Phone: 914-664-9322