MEDICARE: MERMAID 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1427764281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERMAID MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	3682A NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5303
Country	:	US
Telephone Number	:	929-219-3000
Fax Number	:	929-219-4000

Provider Business Practice Location Address
First Line	:	3682A NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5303
Country	:	US
Telephone Number	:	929-219-3000
Fax Number	:	929-219-4000

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID AGAYEV
Credential	:
Telephone Number	:	929-219-3000

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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