Provider Demographics
NPI:1073903217
Name:MIISUPPLY LLC
Entity Type:Organization
Organization Name:MIISUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-279-6622
Mailing Address - Street 1:450 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1135
Mailing Address - Country:US
Mailing Address - Phone:516-279-6622
Mailing Address - Fax:
Practice Address - Street 1:450 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1135
Practice Address - Country:US
Practice Address - Phone:516-279-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2017597332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies