Healthcare Provider Details

I. General information

NPI: 1215827183
Provider Name (Legal Business Name): MEDI EASE SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 CENTRAL PARK AVE
YONKERS NY
10704
US

IV. Provider business mailing address

560 HUDSON ST STE 301
HACKENSACK NJ
07601-6655
US

V. Phone/Fax

Practice location:
  • Phone: 347-213-6894
  • Fax: 212-888-6024
Mailing address:
  • Phone: 201-641-2125
  • Fax: 201-641-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALTAGRACIA DE JESUS
Title or Position: OWNER
Credential:
Phone: 347-213-6894