Healthcare Provider Details

I. General information

NPI: 1619234739
Provider Name (Legal Business Name): NYC HEALTHMED SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FIFTH AVENUE SUITE 1204
NEW YORK NY
10017
US

IV. Provider business mailing address

501 FIFTH AVENUE SUITE 1204
NEW YORK NY
10017
US

V. Phone/Fax

Practice location:
  • Phone: 646-998-8068
  • Fax:
Mailing address:
  • Phone: 646-998-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: HAZEL KUDERA
Title or Position: MEMBER
Credential:
Phone: 646-998-8068