Provider Demographics
NPI:1376564385
Name:VERRAZANO MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:VERRAZANO MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUTSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-564-1567
Mailing Address - Street 1:1117 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2803
Mailing Address - Country:US
Mailing Address - Phone:718-564-1567
Mailing Address - Fax:718-564-1569
Practice Address - Street 1:1117 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2803
Practice Address - Country:US
Practice Address - Phone:718-564-1567
Practice Address - Fax:718-564-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1209201332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5642500001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT