Provider Demographics
NPI:1508206277
Name:FIDELIS MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:FIDELIS MEDICAL SUPPLY LLC
Other - Org Name:THIENDY ELIZER SOLE MBR
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:THIENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-681-5652
Mailing Address - Street 1:8301 AVENUE K
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4233
Mailing Address - Country:US
Mailing Address - Phone:347-681-5652
Mailing Address - Fax:718-504-6161
Practice Address - Street 1:8301 AVENUE K
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4233
Practice Address - Country:US
Practice Address - Phone:347-681-5652
Practice Address - Fax:718-504-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies