Provider Demographics
NPI:1710253414
Name:METROCARE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:METROCARE MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:IKECHUKWU
Authorized Official - Last Name:IGBOEKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-374-3266
Mailing Address - Street 1:16117 N CONDUIT AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4436
Mailing Address - Country:US
Mailing Address - Phone:718-374-3266
Mailing Address - Fax:718-374-3276
Practice Address - Street 1:11033 SUTPHIN BLVD APT 1
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5757
Practice Address - Country:US
Practice Address - Phone:718-374-3266
Practice Address - Fax:718-374-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies