MEDICARE: VS 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	:	1457114001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VS MEDICAL SUPPLY INC

Provider Business Mailing Address
First Line	:	8264 AUSTIN ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1444
Country	:	US
Telephone Number	:	347-233-4400
Fax Number	:	347-233-2504

Provider Business Practice Location Address
First Line	:	8264 AUSTIN ST
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-1444
Country	:	US
Telephone Number	:	347-233-4400
Fax Number	:	347-233-2504

Authorized Official
Title or Position	:	OWNER
Name	:	YAKOUBOV VIACHESLAV
Credential	:
Telephone Number	:	929-604-5886

Provider Enumeration Date	:	02/05/2024
Last Update Date	:	02/05/2024

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