Provider Demographics
NPI:1679275820
Name:LIFE MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:LIFE MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YANKIL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ABRAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-456-1315
Mailing Address - Street 1:9914 63RD RD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1940
Mailing Address - Country:US
Mailing Address - Phone:917-456-1315
Mailing Address - Fax:917-456-1316
Practice Address - Street 1:9914 63RD RD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1940
Practice Address - Country:US
Practice Address - Phone:917-456-1315
Practice Address - Fax:917-456-1316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies