Provider Demographics
NPI:1861474157
Name:CYNNIES MEDICAL SUPPLY HOME EQUIPMENT CO.
Entity Type:Organization
Organization Name:CYNNIES MEDICAL SUPPLY HOME EQUIPMENT CO.
Other - Org Name:CYNNIES MEDICAL SUPPLY HOME EQUIPMENT CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OSITA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:N/A
Authorized Official - Phone:562-984-0550
Mailing Address - Street 1:PO BOX 17894
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-7894
Mailing Address - Country:US
Mailing Address - Phone:562-984-0550
Mailing Address - Fax:562-984-0552
Practice Address - Street 1:353 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-4633
Practice Address - Country:US
Practice Address - Phone:562-984-0550
Practice Address - Fax:562-984-0552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103544 & 17854332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5198910001Medicare ID - Type UnspecifiedDURABLE MEDICAL EQUIPMENT