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General NPI Number Information
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NPI Number | 1619541901
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Entity Type | Organization
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Legal Business Name | ONE SOURCE SURGICAL SUPPLIES LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 1 WINCHESTER RD
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City | WHITE PLAINS
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State | NY
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Zip | 10601
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Country | US
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Telephone | 914-948-4878
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Fax | 866-486-4959
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Provider Business Mailing Address
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Address Line | PO BOX 72
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City | WHITE PLAINS
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State | NY
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Zip | 10602-0072
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Country | US
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Telephone | 914-948-4878
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Fax | 866-486-4959
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. JAYANT K THAKER
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Credential | R.PH.
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Telephone | 914-948-4878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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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 |
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License Number State |
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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 |
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License Number State |
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