MEDICARE: VIP MED 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

General Provider Information

NPI Number	:	1336929280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP MED SUPPLY INC.

Provider Business Mailing Address
First Line	:	254 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1205
Country	:	US
Telephone Number	:	718-576-6033
Fax Number	:	718-576-6034

Provider Business Practice Location Address
First Line	:	254 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1205
Country	:	US
Telephone Number	:	718-576-6033
Fax Number	:	718-576-6034

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YAN AGARONOV
Credential	:
Telephone Number	:	917-941-5559

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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