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General NPI Number Information
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NPI Number | 1275569675
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Entity Type | Organization
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Legal Business Name | D AND E SUPPLIES LLC
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Dates
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Enumeration Date | 06/25/2006
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 4620 N HIATUS RD
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City | SUNRISE
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State | FL
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Zip | 33351-7909
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Country | US
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Telephone | 954-747-5531
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Fax | 954-572-2899
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Provider Business Mailing Address
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Address Line | 4620 N HIATUS RD
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City | SUNRISE
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State | FL
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Zip | 33351-7909
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Country | US
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Telephone | 954-747-5531
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Fax | 954-572-2899
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. BRIAN M GORDON
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Credential | J.D.
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Telephone | 954-747-5531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 1312768
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 1312768
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1312768
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License Number State | FL
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