MEDICARE: SPECSTACULAR, 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		NY

General Provider Information

NPI Number	:	1225127475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECSTACULAR, INC

Provider Business Mailing Address
First Line	:	8949 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8949 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6437
Country	:	US
Telephone Number	:	718-372-1212
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LYDIA BARCELONA-STRONG
Credential	:
Telephone Number	:	718-372-1212

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/21/2022

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