MEDICARE: VICHRIS 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	:	1639300338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICHRIS MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	1113 E 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2509
Country	:	US
Telephone Number	:	917-930-8001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1113 E 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2509
Country	:	US
Telephone Number	:	917-930-8001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VICTOR EGUAOJE
Credential	:
Telephone Number	:	917-930-8001

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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