MEDICARE: CROWN GERIATRICS SUPPLY CORP

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	113082862	NY

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	:	1831201458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROWN GERIATRICS SUPPLY CORP

Provider Business Mailing Address
First Line	:	1840 58TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2027
Country	:	US
Telephone Number	:	917-751-8965
Fax Number	:	718-701-5716

Provider Business Practice Location Address
First Line	:	1613 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6310
Country	:	US
Telephone Number	:	718-645-4433
Fax Number	:	718-645-7241

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. BENJAMIN WEBSTER
Credential	:
Telephone Number	:	917-751-8965

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	12/05/2017

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Directions to “CROWN GERIATRICS SUPPLY CORP ” Practice Location

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