Provider Demographics
NPI:1003247297
Name:REVIVAL DURABLE MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:REVIVAL DURABLE MEDICAL EQUIPMENT INC
Other - Org Name:REVIVAL DURABLE MEDICAL EQUIPMENT INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-625-2723
Mailing Address - Street 1:136-69 41ST AVE 1FL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2433
Mailing Address - Country:US
Mailing Address - Phone:718-888-1535
Mailing Address - Fax:718-888-9154
Practice Address - Street 1:136-69 41AVE 1FL
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2433
Practice Address - Country:US
Practice Address - Phone:718-888-1535
Practice Address - Fax:718-888-9154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1462251332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment