Provider Demographics
NPI:1760760755
Name:ALL SOUTH SHORE MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ALL SOUTH SHORE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:O
Authorized Official - Last Name:EGWABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-984-7845
Mailing Address - Street 1:586 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3501
Mailing Address - Country:US
Mailing Address - Phone:516-543-5690
Mailing Address - Fax:516-543-5691
Practice Address - Street 1:586 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3501
Practice Address - Country:US
Practice Address - Phone:516-543-5690
Practice Address - Fax:516-543-5691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies