Healthcare Provider Details

I. General information

NPI: 1508728858
Provider Name (Legal Business Name): MEDICA SUPPLY AND SOURCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WORLD TRADE CTR STE 8500
NEW YORK NY
10007-0089
US

IV. Provider business mailing address

1 WORLD TRADE CTR STE 8500
NEW YORK NY
10007-0089
US

V. Phone/Fax

Practice location:
  • Phone: 916-340-1975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SYED ANWAR
Title or Position: CEO
Credential:
Phone: 916-340-1975