Provider Demographics
NPI:1740561695
Name:SOFACO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:SOFACO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COMFORT
Authorized Official - Middle Name:
Authorized Official - Last Name:OLAGUNDOYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-381-0966
Mailing Address - Street 1:460 E 21ST ST
Mailing Address - Street 2:3J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 E 21ST ST
Practice Address - Street 2:3J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6064
Practice Address - Country:US
Practice Address - Phone:347-381-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies