Provider Demographics
NPI:1710225511
Name:ACCREDITED MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:ACCREDITED MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DESANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-296-8109
Mailing Address - Street 1:8416 JAMAICA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1920
Mailing Address - Country:US
Mailing Address - Phone:718-296-8109
Mailing Address - Fax:888-993-0899
Practice Address - Street 1:8416 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-1920
Practice Address - Country:US
Practice Address - Phone:718-296-8109
Practice Address - Fax:888-993-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6867720001Medicare NSC