Provider Demographics
NPI:1649575655
Name:NEW FREEDOM MEDICAL SUPPLY
Entity Type:Organization
Organization Name:NEW FREEDOM MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:EKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-821-6574
Mailing Address - Street 1:11 VIOLET RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8736
Mailing Address - Country:US
Mailing Address - Phone:631-821-6574
Mailing Address - Fax:
Practice Address - Street 1:11 VIOLET RD
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8736
Practice Address - Country:US
Practice Address - Phone:631-821-6574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies