1669616728 NPI number — QUALITY CARE MEDICAL SUPPLY

Table of content: (NPI 1669616728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669616728 NPI number — QUALITY CARE MEDICAL SUPPLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY CARE MEDICAL SUPPLY
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:
1669616728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11551 237TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11003-3924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
191-770-1514
Provider Business Mailing Address Fax Number:
516-612-2542

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11551 237TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11003-3924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
191-770-1514
Provider Business Practice Location Address Fax Number:
516-612-2542
Provider Enumeration Date:
04/20/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ALAWURU
Authorized Official First Name:
EVANS
Authorized Official Middle Name:
O.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
917-701-5143

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  1420716 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 1420716 , 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: 1420716 . This is a "NEW YORK CITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com