Provider Demographics
NPI:1407186604
Name:ELVINA SURGICAL SUPPLIES INC,
Entity Type:Organization
Organization Name:ELVINA SURGICAL SUPPLIES INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MEYER
Authorized Official - Middle Name:
Authorized Official - Last Name:AGARUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-459-1922
Mailing Address - Street 1:1801 OCEAN AVE
Mailing Address - Street 2:SUIT 7B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:917-459-1922
Mailing Address - Fax:212-658-9109
Practice Address - Street 1:1801 OCEAN AVE
Practice Address - Street 2:SUIT 7B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6269
Practice Address - Country:US
Practice Address - Phone:917-459-1922
Practice Address - Fax:212-658-9109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies