Healthcare Provider Details

I. General information

NPI: 1114547973
Provider Name (Legal Business Name): LI MEDICAL SUPPLY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 VETERANS HWY STE 8
RONKONKOMA NY
11779-7680
US

IV. Provider business mailing address

2805 VETERANS HWY STE 8
RONKONKOMA NY
11779-7680
US

V. Phone/Fax

Practice location:
  • Phone: 631-738-9539
  • Fax:
Mailing address:
  • Phone: 631-738-9539
  • 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: DR. JAMES LAMBERT
Title or Position: OWNER
Credential: DC
Phone: 516-971-1306