Healthcare Provider Details

I. General information

NPI: 1508930223
Provider Name (Legal Business Name): MUFSON ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 W MAIN ST
SMITHTOWN NY
11787-2642
US

IV. Provider business mailing address

196 W MAIN ST
SMITHTOWN NY
11787-2642
US

V. Phone/Fax

Practice location:
  • Phone: 631-360-7776
  • Fax: 631-360-7862
Mailing address:
  • Phone: 631-360-7776
  • Fax: 631-360-7862

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 Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ROGER MUFSON
Title or Position: PRESIDENT
Credential:
Phone: 631-360-7776