Provider Demographics
NPI:1255676466
Name:IDEAL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:IDEAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FOSTER
Authorized Official - Middle Name:
Authorized Official - Last Name:AIMUFUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-233-8600
Mailing Address - Street 1:18826 119TH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-3604
Mailing Address - Country:US
Mailing Address - Phone:347-233-8600
Mailing Address - Fax:
Practice Address - Street 1:18826 119TH RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-3604
Practice Address - Country:US
Practice Address - Phone:347-233-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies