Provider Demographics
NPI:1598374589
Name:SUMMER MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SUMMER MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:AGAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-242-7000
Mailing Address - Street 1:1055 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5662
Mailing Address - Country:US
Mailing Address - Phone:929-242-7000
Mailing Address - Fax:929-242-8000
Practice Address - Street 1:1055 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5662
Practice Address - Country:US
Practice Address - Phone:929-242-7000
Practice Address - Fax:929-242-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies