MEDICARE: PRESTIGIOUS SUPPLY LLC

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
2	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1457145641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGIOUS SUPPLY LLC

Provider Business Mailing Address
First Line	:	1416 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1416 E 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5515
Country	:	US
Telephone Number	:	929-444-5710
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBINA SABIR
Credential	:
Telephone Number	:	929-444-5710

Provider Enumeration Date	:	04/04/2025
Last Update Date	:	12/09/2025

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Directions to “PRESTIGIOUS SUPPLY LLC ” Practice Location

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