Healthcare Provider Details

I. General information

NPI: 1356693162
Provider Name (Legal Business Name): INSURED MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 LONG BEACH RD
OCEANSIDE NY
11572-5049
US

IV. Provider business mailing address

3340 LONG BEACH RD
OCEANSIDE NY
11572-5049
US

V. Phone/Fax

Practice location:
  • Phone: 347-400-5373
  • Fax:
Mailing address:
  • Phone: 347-400-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateNY

VIII. Authorized Official

Name: LOUIS I NWOKEOCHA
Title or Position: MANAGING DIRECTOR
Credential: M.D
Phone: 347-400-5373