MEDICARE: EDY 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

General Provider Information

NPI Number	:	1093640955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDY SUPPLY INC

Provider Business Mailing Address
First Line	:	1 W 125TH ST STE 236
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4524
Country	:	US
Telephone Number	:	917-209-3906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 W 125TH ST STE 236
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-4524
Country	:	US
Telephone Number	:	917-209-3906
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	EDUARD YELTSOV
Credential	:
Telephone Number	:	917-209-3906

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “EDY SUPPLY INC ” Practice Location

Language	Start Address	Practice Location

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