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General NPI Number Information
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NPI Number | 1508728858
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Entity Type | Organization
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Legal Business Name | MEDICA SUPPLY AND SOURCE LLC
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Dates
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Enumeration Date | 11/25/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 1 WORLD TRADE CTR STE 8500
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City | NEW YORK
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State | NY
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Zip | 10007-0089
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Country | US
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Telephone | 916-340-1975
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WORLD TRADE CTR STE 8500
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City | NEW YORK
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State | NY
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Zip | 10007-0089
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SYED ANWAR
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Credential |
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Telephone | 916-340-1975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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