Provider Demographics
NPI:1750326278
Name:MAX MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MAX MEDICAL SUPPLY
Other - Org Name:MAX MEDICAL SUPPLY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUSHMAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-779-1635
Mailing Address - Street 1:7528 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6538
Mailing Address - Country:US
Mailing Address - Phone:718-779-1635
Mailing Address - Fax:718-779-1784
Practice Address - Street 1:75-28 37 AVE.
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-779-1635
Practice Address - Fax:718-779-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4849100001Medicare ID - Type Unspecified