Provider Demographics
NPI:1497755722
Name:MAYFLOWER MEDICAL SUPPLIES COMPANY, INC.
Entity Type:Organization
Organization Name:MAYFLOWER MEDICAL SUPPLIES COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-259-9500
Mailing Address - Street 1:1726 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3716
Mailing Address - Country:US
Mailing Address - Phone:718-259-9500
Mailing Address - Fax:718-837-8178
Practice Address - Street 1:1726 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3716
Practice Address - Country:US
Practice Address - Phone:718-259-9500
Practice Address - Fax:718-837-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304381332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365662Medicaid
NY02365662Medicaid