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General NPI Number Information
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NPI Number | 1588906960
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Entity Type | Organization
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Legal Business Name | STAYWELL MEDICAL SUPPLIES
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Dates
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Enumeration Date | 03/22/2013
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Last Update Date | 03/20/2014
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Provider Practice Location Address
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Address Line | 18836 JAMAICA AVE
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City | JAMAICA
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State | NY
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Zip | 11423-2512
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Country | US
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Telephone | 718-740-0200
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Fax | 718-740-0202
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Provider Business Mailing Address
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Address Line | 18836 JAMAICA AVE
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City | HOLLIS
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State | NY
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Zip | 11423-2512
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Country | US
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Telephone | 718-740-0200
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Fax | 718-740-0202
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Authorized Official
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Title or Position | CEO
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Name | MISS CAROLINE EZEOGU
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Credential |
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Telephone | 718-415-0311
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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 | 1463747
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License Number State | NY
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