MEDICARE: SIMPLY DIVINE 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		NY

General Provider Information

NPI Number	:	1891069068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLY DIVINE MEDICAL SUPPLY

Provider Business Mailing Address
First Line	:	3614 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3686
Country	:	US
Telephone Number	:	347-405-9182
Fax Number	:	888-328-0487

Provider Business Practice Location Address
First Line	:	3614 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11203-3686
Country	:	US
Telephone Number	:	347-405-9182
Fax Number	:	888-328-0487

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. JILLIEN K DURRANT
Credential	:
Telephone Number	:	347-405-9182

Provider Enumeration Date	:	03/05/2012
Last Update Date	:	06/21/2019

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