MEDICARE: GENEVA SUPPLY GROUP 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	:	1164103644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENEVA SUPPLY GROUP INC

Provider Business Mailing Address
First Line	:	1880 HYLAN BLVD STE 2R8
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 HYLAN BLVD STE 2R8
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2102
Country	:	US
Telephone Number	:	347-292-7180
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. EUGENE KOGAN
Credential	:
Telephone Number	:	347-292-7180

Provider Enumeration Date	:	07/27/2023
Last Update Date	:	07/27/2023

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