Provider Demographics
NPI:1497078422
Name:ASSURANCE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ASSURANCE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASSURANCE
Authorized Official - Middle Name:MEDICAL
Authorized Official - Last Name:LLC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-676-0570
Mailing Address - Street 1:1423 STANLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-6403
Mailing Address - Country:US
Mailing Address - Phone:718-676-0570
Mailing Address - Fax:718-676-0571
Practice Address - Street 1:1423 STANLEY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-6403
Practice Address - Country:US
Practice Address - Phone:718-676-0570
Practice Address - Fax:718-676-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1210860332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies