Healthcare Provider Details

I. General information

NPI: 1619541901
Provider Name (Legal Business Name): ONE SOURCE SURGICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WINCHESTER RD
WHITE PLAINS NY
10601
US

IV. Provider business mailing address

PO BOX 72
WHITE PLAINS NY
10602-0072
US

V. Phone/Fax

Practice location:
  • Phone: 914-948-4878
  • Fax: 866-486-4959
Mailing address:
  • Phone: 914-948-4878
  • Fax: 866-486-4959

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 Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAYANT K THAKER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: R.PH.
Phone: 914-948-4878