MEDICARE: MOUNT OLIVE DME, LLC

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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1972849305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT OLIVE DME, LLC

Provider Business Mailing Address
First Line	:	68 HAWTHORNE ST APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5763
Country	:	US
Telephone Number	:	516-487-5044
Fax Number	:	516-487-5043

Provider Business Practice Location Address
First Line	:	68 HAWTHORNE ST APT 2
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5763
Country	:	US
Telephone Number	:	516-487-5044
Fax Number	:	516-487-5043

Authorized Official
Title or Position	:	MANAGER
Name	:	RACHEL MIZRAHI
Credential	:
Telephone Number	:	516-487-5044

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/12/2012

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