MEDICARE: ADVANCED ORTHOMEDICAL SUPPLIES 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	915661944	NY

General Provider Information

NPI Number	:	1275789281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ORTHOMEDICAL SUPPLIES INC

Provider Business Mailing Address
First Line	:	4461 11TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5117
Country	:	US
Telephone Number	:	516-855-2300
Fax Number	:	516-977-0412

Provider Business Practice Location Address
First Line	:	4461 11TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5117
Country	:	US
Telephone Number	:	516-855-2300
Fax Number	:	516-977-0412

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIUSZ P GROMUL
Credential	:
Telephone Number	:	516-855-2300

Provider Enumeration Date	:	08/09/2008
Last Update Date	:	08/09/2008

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