Provider Demographics
NPI:1649423534
Name:MONACK MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:MONACK MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:KESTER
Authorized Official - Middle Name:CHIEKEZI
Authorized Official - Last Name:ATUMONYOGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-221-2075
Mailing Address - Street 1:145 E 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-3801
Mailing Address - Country:US
Mailing Address - Phone:718-221-2075
Mailing Address - Fax:718-221-2529
Practice Address - Street 1:145 E 98TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3801
Practice Address - Country:US
Practice Address - Phone:718-221-2075
Practice Address - Fax:718-221-2529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6360790001Medicare NSC