MEDICARE: VERRAZANO MEDICAL 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	332BX2000X	Oxygen Equipment & Supplies (DME)	1209201	NY

General Provider Information

NPI Number	:	1376564385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERRAZANO MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	1117 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2803
Country	:	US
Telephone Number	:	718-564-1567
Fax Number	:	718-564-1569

Provider Business Practice Location Address
First Line	:	1117 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2803
Country	:	US
Telephone Number	:	718-564-1567
Fax Number	:	718-564-1569

Authorized Official
Title or Position	:	QWNER
Name	:	OLEXANDER KAUTSIS
Credential	:
Telephone Number	:	718-564-1567

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	08/22/2020

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