=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649442153
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIBAM MEDICAL SUPPLY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 07/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 189-07 JAMAICA AVENUE
-----------------------------------------------------
City | HOLLIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-464-8410
-----------------------------------------------------
Fax | 718-464-8411
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 189-07 JAMAICA AVENUE
-----------------------------------------------------
City | HOLLIS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-464-8410
-----------------------------------------------------
Fax | 718-464-8411
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. MAJEMITE O OKERENTUGBA
-----------------------------------------------------
Credential | LICENSED PRACTICAL N
-----------------------------------------------------
Telephone | 718-464-8410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------