Provider Demographics
NPI:1619070406
Name:AVS MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:AVS MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALMYRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CECKAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-505-8555
Mailing Address - Street 1:6276 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3738
Mailing Address - Country:US
Mailing Address - Phone:718-505-8555
Mailing Address - Fax:718-651-5566
Practice Address - Street 1:6276 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3738
Practice Address - Country:US
Practice Address - Phone:718-505-8555
Practice Address - Fax:718-651-5566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1100008332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335468Medicaid
NY4398470001Medicare ID - Type Unspecified