Healthcare Provider Details

I. General information

NPI: 1336028042
Provider Name (Legal Business Name): ACTIVE ASSIST MEDICAL SUPPLIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3296 PALISADES CENTER DR
WEST NYACK NY
10994-6602
US

IV. Provider business mailing address

3296 PALISADES CENTER DR
WEST NYACK NY
10994-6602
US

V. Phone/Fax

Practice location:
  • Phone: 845-354-7779
  • Fax: 845-354-7780
Mailing address:
  • Phone: 845-354-7779
  • Fax: 845-354-7780

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: MR. RICHARD SERRANO
Title or Position: OWNER
Credential:
Phone: 845-354-7779