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General NPI Number Information
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NPI Number | 1104383819
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Entity Type | Organization
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Legal Business Name | HARBOUR MEDICAL SUPPLY LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 02/28/2019
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Provider Practice Location Address
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Address Line | 70 FOREST AVE STE 2C
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City | GLEN COVE
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State | NY
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Zip | 11542-2117
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Country | US
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Telephone | 516-671-2166
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Fax | 516-674-2166
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Provider Business Mailing Address
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Address Line | 70 FOREST AVE STE 2C
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City | GLEN COVE
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State | NY
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Zip | 11542-2117
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Country | US
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Telephone | 516-671-2166
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Fax | 516-674-2166
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MORRIS ETHAN BORATIN
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Credential |
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Telephone | 516-671-2166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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