MEDICARE: MASTERS MEDICAL SUPPLY

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	:	1518600527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASTERS MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	8711 118TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2528
Country	:	US
Telephone Number	:	347-249-5094
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 118TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2528
Country	:	US
Telephone Number	:	347-249-5094
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	ALIX LAURENT
Credential	:
Telephone Number	:	347-249-5094

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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