Provider Demographics
NPI:1619153814
Name:ADVANCED MEDICAL SUPPLY
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NKEM
Authorized Official - Middle Name:
Authorized Official - Last Name:UDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-467-4600
Mailing Address - Street 1:1162 SAINT JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2645
Mailing Address - Country:US
Mailing Address - Phone:718-467-4600
Mailing Address - Fax:718-467-0075
Practice Address - Street 1:1162 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2645
Practice Address - Country:US
Practice Address - Phone:718-467-4600
Practice Address - Fax:718-467-0075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50599332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4794550001Medicare NSC