MEDICARE: KEYSTONE SUPPLY GROUP 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	:	1861322828
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE SUPPLY GROUP INC

Provider Business Mailing Address
First Line	:	2329 NOSTRAND AVE STE 100
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3949
Country	:	US
Telephone Number	:	301-294-0093
Fax Number	:

Provider Business Practice Location Address
First Line	:	2329 NOSTRAND AVE STE 100
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-3949
Country	:	US
Telephone Number	:	301-294-0093
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DILSHOD NURMAMADOV
Credential	:
Telephone Number	:	301-294-0093

Provider Enumeration Date	:	05/21/2026
Last Update Date	:	05/21/2026

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