Healthcare Provider Details

I. General information

NPI: 1740116912
Provider Name (Legal Business Name): PLATINUM SUPPLY GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9305 ASHTON RD APT C8
PHILADELPHIA PA
19114-3448
US

IV. Provider business mailing address

9305 ASHTON RD APT C8
PHILADELPHIA PA
19114-3448
US

V. Phone/Fax

Practice location:
  • Phone: 301-398-2855
  • Fax:
Mailing address:
  • Phone: 301-398-2855
  • Fax:

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: MIRZAEV ELDORBEK
Title or Position: DIRECTOR
Credential:
Phone: 301-398-2855