Provider Demographics
NPI:1851543284
Name:NEPTUNE MEDICAL & SURGICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:NEPTUNE MEDICAL & SURGICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AULOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-513-6318
Mailing Address - Street 1:1048-1050 OCEANVIEW AVE
Mailing Address - Street 2:NEPTUNE MEDICAL & SURGICAL SUPPLY, INC.
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5441
Mailing Address - Country:US
Mailing Address - Phone:718-513-6318
Mailing Address - Fax:718-513-6319
Practice Address - Street 1:1048-1050 OCEANVIEW AVE
Practice Address - Street 2:NEPTUNE MEDICAL & SURGICAL SUPPLY, INC.
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5441
Practice Address - Country:US
Practice Address - Phone:718-513-6318
Practice Address - Fax:718-513-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224L00000X
NY1300575332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6166190001Medicare NSC