MEDICARE: NE MED 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	:	1609049568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NE MED SUPPLY INC

Provider Business Mailing Address
First Line	:	6047 TAMPA AVE
Second Line	:	STE 107
City	:	TARZANA
State	:	CA
Zip	:	91356-1158
Country	:	US
Telephone Number	:	818-996-2226
Fax Number	:	818-996-2227

Provider Business Practice Location Address
First Line	:	6047 TAMPA AVE
Second Line	:	STE 107
City	:	TARZANA
State	:	CA
Zip	:	91356-1158
Country	:	US
Telephone Number	:	818-996-2226
Fax Number	:	818-996-2227

Authorized Official
Title or Position	:	OWNER
Name	:	NINA EGIAZAROVA
Credential	:
Telephone Number	:	818-996-2226

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	01/23/2009

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Directions to “NE MED SUPPLY INC ” Practice Location

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