Provider Demographics
NPI:1164062543
Name:EASTERN MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:EASTERN MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-238-2283
Mailing Address - Street 1:1859 LEONARD LN
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4933
Mailing Address - Country:US
Mailing Address - Phone:866-367-6682
Mailing Address - Fax:
Practice Address - Street 1:101 DUPONT ST STE 22
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1688
Practice Address - Country:US
Practice Address - Phone:516-238-2283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No252Y00000XAgenciesEarly Intervention Provider Agency