Provider Demographics
NPI:1124201785
Name:SDNY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SDNY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-575-3301
Mailing Address - Street 1:6939 YELLOWSTONE BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3760
Mailing Address - Country:US
Mailing Address - Phone:718-575-0550
Mailing Address - Fax:
Practice Address - Street 1:6939 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-3760
Practice Address - Country:US
Practice Address - Phone:718-575-0550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6041800001Medicare NSC