Provider Demographics
NPI:1558992669
Name:THE MEDICAL SUPPLY GUY INC.
Entity Type:Organization
Organization Name:THE MEDICAL SUPPLY GUY INC.
Other - Org Name:MEDIXSOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-547-5815
Mailing Address - Street 1:110 COVES RUN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-1005
Mailing Address - Country:US
Mailing Address - Phone:516-547-5815
Mailing Address - Fax:
Practice Address - Street 1:333 GLEN HEAD RD STE 205
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1960
Practice Address - Country:US
Practice Address - Phone:516-490-2136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY180577OtherLICENSE