MEDICARE: QUEENS SURGICAL SUPPLY CO., 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

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	:	1336138916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUEENS SURGICAL SUPPLY CO., INC.

Provider Business Mailing Address
First Line	:	17-19 INDUSTRIAL AVE
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1605
Country	:	US
Telephone Number	:	201-840-4100
Fax Number	:	201-840-4117

Provider Business Practice Location Address
First Line	:	17-19 INDUSTRIAL AVE
Second Line	:
City	:	FAIRVIEW
State	:	NJ
Zip	:	07022-1605
Country	:	US
Telephone Number	:	201-840-4100
Fax Number	:	201-840-4117

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICHARD SPINDEL
Credential	:
Telephone Number	:	201-840-4100

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	07/12/2007

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