Provider Demographics
NPI:1336138916
Name:QUEENS SURGICAL SUPPLY CO., INC.
Entity Type:Organization
Organization Name:QUEENS SURGICAL SUPPLY CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-840-4100
Mailing Address - Street 1:17-19 INDUSTRIAL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:NJ
Mailing Address - Zip Code:07022-1605
Mailing Address - Country:US
Mailing Address - Phone:201-840-4100
Mailing Address - Fax:201-840-4117
Practice Address - Street 1:17-19 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:NJ
Practice Address - Zip Code:07022-1605
Practice Address - Country:US
Practice Address - Phone:201-840-4100
Practice Address - Fax:201-840-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00320627Medicaid
NY0342120001Medicare NSC