MEDICARE: ADVENTURE MEDICAL SUPPLY LLC

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
2	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1699147546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVENTURE MEDICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	3507 AVE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3454
Country	:	US
Telephone Number	:	718-564-6225
Fax Number	:

Provider Business Practice Location Address
First Line	:	3507 AVE S
Second Line	:	GROUND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3454
Country	:	US
Telephone Number	:	718-564-6225
Fax Number	:	718-564-6226

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ASHER TSVI MITTELDORF
Credential	:	MBA, ATP
Telephone Number	:	718-564-6225

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	07/21/2022

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