Provider Demographics
NPI:1376183061
Name:SUPREME MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:SUPREME MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:OGBONUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-804-4287
Mailing Address - Street 1:3246 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-6438
Mailing Address - Country:US
Mailing Address - Phone:646-804-4287
Mailing Address - Fax:
Practice Address - Street 1:88 WILLIAM ST APT 2F
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-6183
Practice Address - Country:US
Practice Address - Phone:646-804-4287
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies