MEDICARE: GOOD CARE SUPPLY 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	:	1942765920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD CARE SUPPLY INC

Provider Business Mailing Address
First Line	:	8711 118TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2528
Country	:	US
Telephone Number	:	929-499-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	8711 118TH ST
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2528
Country	:	US
Telephone Number	:	929-499-3506
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDUARD ZAVLYANOV
Credential	:
Telephone Number	:	929-499-3506

Provider Enumeration Date	:	02/05/2019
Last Update Date	:	03/17/2020

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