MEDICARE: LANDMARK MEDICAL SUPPLIES, 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	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649356635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK MEDICAL SUPPLIES, INC.

Provider Business Mailing Address
First Line	:	3311 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2605
Country	:	US
Telephone Number	:	718-338-7750
Fax Number	:	718-338-6158

Provider Business Practice Location Address
First Line	:	3311 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234
Country	:	US
Telephone Number	:	718-338-7750
Fax Number	:	718-338-6158

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KELVIN JEFFCOAT
Credential	:	RRT
Telephone Number	:	718-338-7750

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	05/05/2008

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