MEDICARE: PRIME SURGICAL 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	1136374	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134209257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME SURGICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	2105 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3609
Country	:	US
Telephone Number	:	718-891-2000
Fax Number	:	718-891-2209

Provider Business Practice Location Address
First Line	:	2105 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3609
Country	:	US
Telephone Number	:	718-891-2000
Fax Number	:	718-891-2209

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VADIM POVZLOV
Credential	:
Telephone Number	:	718-891-2000

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/23/2007

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