Provider Demographics
NPI:1346482510
Name:LIGHTNING MEDICAL & SURGICAL SUPPLIES,LLC
Entity Type:Organization
Organization Name:LIGHTNING MEDICAL & SURGICAL SUPPLIES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-234-8624
Mailing Address - Street 1:564 MEACHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3866
Mailing Address - Country:US
Mailing Address - Phone:877-972-9911
Mailing Address - Fax:516-488-0159
Practice Address - Street 1:564 MEACHAM AVE
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3866
Practice Address - Country:US
Practice Address - Phone:877-972-9911
Practice Address - Fax:516-488-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090129000004332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6458010001Medicare NSC