Provider Demographics
NPI:1104383819
Name:HARBOUR MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:HARBOUR MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:ETHAN
Authorized Official - Last Name:BORATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-671-2166
Mailing Address - Street 1:70 FOREST AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2117
Mailing Address - Country:US
Mailing Address - Phone:516-671-2166
Mailing Address - Fax:516-674-2166
Practice Address - Street 1:70 FOREST AVE STE 2C
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2117
Practice Address - Country:US
Practice Address - Phone:516-671-2166
Practice Address - Fax:516-674-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies