Provider Demographics
NPI:1760633242
Name:SANSBURY MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:SANSBURY MEDICAL EQUIPMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:SANSBURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-948-9755
Mailing Address - Street 1:3976 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2408
Mailing Address - Country:US
Mailing Address - Phone:718-948-9755
Mailing Address - Fax:718-948-9756
Practice Address - Street 1:3976 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2408
Practice Address - Country:US
Practice Address - Phone:718-948-9755
Practice Address - Fax:718-948-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2009-06-19
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
NY01245312Medicaid
NY01245312Medicaid