Provider Demographics
NPI:1780633016
Name:AB SURGICAL SUPPLY CO., INC.
Entity Type:Organization
Organization Name:AB SURGICAL SUPPLY CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BOUSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:914-664-9322
Mailing Address - Street 1:238 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1243
Mailing Address - Country:US
Mailing Address - Phone:914-664-9322
Mailing Address - Fax:
Practice Address - Street 1:238 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1243
Practice Address - Country:US
Practice Address - Phone:914-664-9322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0144110001Medicare NSC