MEDICARE: DEPENDABLE MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	332BC3200X	NY

General Provider Information

NPI Number	:	1083606875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPENDABLE MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	1740 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6502
Country	:	US
Telephone Number	:	718-375-0090
Fax Number	:	718-375-3503

Provider Business Practice Location Address
First Line	:	1740 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6502
Country	:	US
Telephone Number	:	718-375-0090
Fax Number	:	718-375-3503

Authorized Official
Title or Position	:	PRESIDENT
Name	:	OLEG KISELYOV
Credential	:
Telephone Number	:	718-375-0090

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	08/22/2020

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