Provider Demographics
NPI:1679559645
Name:LIFESAVER MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:LIFESAVER MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAVCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-265-6010
Mailing Address - Street 1:2350 80TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2024
Mailing Address - Country:US
Mailing Address - Phone:718-265-6010
Mailing Address - Fax:718-265-6012
Practice Address - Street 1:2350 80TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2024
Practice Address - Country:US
Practice Address - Phone:718-265-6010
Practice Address - Fax:718-265-6012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1197116332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5512120001Medicare NSC