Provider Demographics
NPI:1609049568
Name:NE MED SUPPLY INC
Entity Type:Organization
Organization Name:NE MED SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGIAZAROVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-996-2226
Mailing Address - Street 1:6047 TAMPA AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1158
Mailing Address - Country:US
Mailing Address - Phone:818-996-2226
Mailing Address - Fax:818-996-2227
Practice Address - Street 1:6047 TAMPA AVE
Practice Address - Street 2:STE 107
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1158
Practice Address - Country:US
Practice Address - Phone:818-996-2226
Practice Address - Fax:818-996-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5924120001Medicare NSC