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General NPI Number Information
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NPI Number | 1952736977
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Entity Type | Organization
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Legal Business Name | ONE SOURCE MEDICAL SUPPLY GROUP
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 13447 166TH PL SUITE 4G
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City | JAMAICA
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State | NY
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Zip | 11434-3853
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Country | US
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Telephone | 718-880-0437
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Fax |
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Provider Business Mailing Address
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Address Line | 13447 166TH PL SUITE 4G
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City | JAMAICA
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State | NY
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Zip | 11434-3853
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Country | US
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Telephone | 718-880-0437
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LESHUN I FAYE
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Credential |
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Telephone | 718-880-0437
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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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