MEDICARE: LISAN 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	332B00000X	Durable Medical Equipment & Medical Supplies	0984160	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2001294-DCA	OTHER	NY	NYC DEPARTMENT OF CONSUMER AFFAIRS

General Provider Information

NPI Number	:	1891713277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISAN MEDICAL SUPPLIES, INC

Provider Business Mailing Address
First Line	:	253 36TH ST
Second Line	:	SUITE 1-10
City	:	BROOKLYN
State	:	NY
Zip	:	11232-2546
Country	:	US
Telephone Number	:	718-530-1450
Fax Number	:	718-280-1333

Provider Business Practice Location Address
First Line	:	253 36TH ST
Second Line	:	SUITE 1-10
City	:	BROOKLYN
State	:	NY
Zip	:	11232-2546
Country	:	US
Telephone Number	:	718-530-1450
Fax Number	:	718-280-1333

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LILIYA SANKINA
Credential	:
Telephone Number	:	718-530-1450

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	02/04/2014

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