Provider Demographics
NPI:1437389764
Name:UNIVERSAL CARE MEDICAL SUPPLY, INC
Entity Type:Organization
Organization Name:UNIVERSAL CARE MEDICAL SUPPLY, INC
Other - Org Name:B&G FOOT CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KVASNITSKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-509-6709
Mailing Address - Street 1:2946 AVENUE S STE 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3229
Mailing Address - Country:US
Mailing Address - Phone:718-509-6709
Mailing Address - Fax:187-975-3829
Practice Address - Street 1:2946 AVENUE S STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3229
Practice Address - Country:US
Practice Address - Phone:718-509-6709
Practice Address - Fax:187-975-3829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03291265Medicaid