Healthcare Provider Details

I. General information

NPI: 1932581170
Provider Name (Legal Business Name): ADVANCED DME SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 02/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 COLUMBUS AVE
TUCKAHOE NY
10707-1706
US

IV. Provider business mailing address

335 COLUMBUS AVE
TUCKAHOE NY
10707-1706
US

V. Phone/Fax

Practice location:
  • Phone: 888-246-7770
  • Fax: 866-380-9611
Mailing address:
  • Phone: 888-246-7770
  • Fax: 866-380-9611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number008387
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number008387
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN CVITKOVIC
Title or Position: PARTNER
Credential: PA,PT,C.PED, CFO,MPH
Phone: 914-393-6993