1154528180 NPI number — A-1 SURGICAL AND MEDICAL SUPPLIES INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154528180 NPI number — A-1 SURGICAL AND MEDICAL SUPPLIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A-1 SURGICAL AND MEDICAL SUPPLIES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154528180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 E JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINEOLA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11501-3123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-741-1087
Provider Business Mailing Address Fax Number:
516-873-7904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-4051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-292-4105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CORSENTINO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT/ORTHOTIST
Authorized Official Telephone Number:
516-292-4105

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  222Z00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02917357 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com