MEDICARE: CITI HEALTH 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	1427029	NY

General Provider Information

NPI Number	:	1558618256
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITI HEALTH MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	18724 LINDEN BLVD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-4026
Country	:	US
Telephone Number	:	347-548-5854
Fax Number	:

Provider Business Practice Location Address
First Line	:	18724 LINDEN BLVD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-4026
Country	:	US
Telephone Number	:	347-548-5854
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MR. CYPRIAN O NGBADI
Credential	:
Telephone Number	:	347-738-7824

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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