Provider Demographics
NPI:1639188246
Name:DIRECT MEDICAL SUPPLIES, INC.
Entity Type:Organization
Organization Name:DIRECT MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-759-4474
Mailing Address - Street 1:17 ERNEST CT
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-5020
Mailing Address - Country:US
Mailing Address - Phone:516-759-4474
Mailing Address - Fax:516-759-5458
Practice Address - Street 1:26 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-5005
Practice Address - Country:US
Practice Address - Phone:516-759-4474
Practice Address - Fax:516-759-5458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01750870Medicaid
NY1065980001Medicare NSC