Provider Demographics
NPI:1750843215
Name:18TH AVE CARE LLC
Entity Type:Organization
Organization Name:18TH AVE CARE LLC
Other - Org Name:MEDICAL AID SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:
Authorized Official - Last Name:BRULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-489-8934
Mailing Address - Street 1:5906 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2201
Mailing Address - Country:US
Mailing Address - Phone:718-682-3606
Mailing Address - Fax:646-849-4359
Practice Address - Street 1:5906 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2201
Practice Address - Country:US
Practice Address - Phone:718-682-3606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-03
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06110205Medicaid