Provider Demographics
NPI:1538292750
Name:LIFECELL MEDICAL MEDICAL SUPPLY
Entity Type:Organization
Organization Name:LIFECELL MEDICAL MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKWUEMEKA
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:UDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-502-9409
Mailing Address - Street 1:22309 135TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2011
Mailing Address - Country:US
Mailing Address - Phone:718-502-9409
Mailing Address - Fax:718-554-7922
Practice Address - Street 1:22309 135TH AVE
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413-2011
Practice Address - Country:US
Practice Address - Phone:718-502-9409
Practice Address - Fax:718-554-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies