Provider Demographics
NPI:1891110334
Name:FIDELITY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:FIDELITY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EKEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-552-1043
Mailing Address - Street 1:22 JULIE CRES
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4908
Mailing Address - Country:US
Mailing Address - Phone:631-552-1043
Mailing Address - Fax:718-228-8173
Practice Address - Street 1:22 JULIE CRES
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4908
Practice Address - Country:US
Practice Address - Phone:631-552-1043
Practice Address - Fax:718-228-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies