Provider Demographics
NPI:1407967581
Name:IMPERIAL SURGICAL SUPPLY CORP.
Entity Type:Organization
Organization Name:IMPERIAL SURGICAL SUPPLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:EDELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-482-9110
Mailing Address - Street 1:7 NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4044
Mailing Address - Country:US
Mailing Address - Phone:516-482-9110
Mailing Address - Fax:516-482-9113
Practice Address - Street 1:7 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4044
Practice Address - Country:US
Practice Address - Phone:516-482-9110
Practice Address - Fax:516-482-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00322394Medicaid
NY0131000001Medicare ID - Type Unspecified