Healthcare Provider Details

I. General information

NPI: 1699452862
Provider Name (Legal Business Name): ADVANCED MEDICAL DME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CHESTNUT RIDGE RD STE 309
SPRING VALLEY NY
10977-5669
US

IV. Provider business mailing address

501 CHESTNUT RIDGE RD STE 309
SPRING VALLEY NY
10977-5669
US

V. Phone/Fax

Practice location:
  • Phone: 845-579-5639
  • Fax:
Mailing address:
  • Phone: 845-579-5639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BEREL KRUG
Title or Position: CEO
Credential:
Phone: 443-929-1569