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General NPI Number Information
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NPI Number | 1649790569
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Entity Type | Organization
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Legal Business Name | SUPER TECH WHEELCHAIR SERVICE AND REPAIR INC
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Dates
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Enumeration Date | 06/21/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 9420 210TH STREET
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428
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Country | US
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Telephone | 347-601-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 9420 210TH ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1525
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Country | US
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Telephone | 347-601-7336
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DOMINIC E HODGE
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Credential |
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Telephone | 347-601-7336
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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 |
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License Number State |
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