Healthcare Provider Details

I. General information

NPI: 1093640955
Provider Name (Legal Business Name): EDY SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W 125TH ST STE 236
NEW YORK NY
10027-4524
US

IV. Provider business mailing address

1 W 125TH ST STE 236
NEW YORK NY
10027-4524
US

V. Phone/Fax

Practice location:
  • Phone: 917-209-3906
  • Fax:
Mailing address:
  • Phone: 917-209-3906
  • 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: EDUARD YELTSOV
Title or Position: CEO
Credential:
Phone: 917-209-3906