Provider Demographics
NPI:1891703179
Name:PSC MEDICAL SUPPLY GROUP INC.
Entity Type:Organization
Organization Name:PSC MEDICAL SUPPLY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-322-6600
Mailing Address - Street 1:10302 93RD ST
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2418
Mailing Address - Country:US
Mailing Address - Phone:718-322-6600
Mailing Address - Fax:718-322-7846
Practice Address - Street 1:103-02 93 ST
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2607
Practice Address - Country:US
Practice Address - Phone:718-322-6600
Practice Address - Fax:718-322-7846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5755620001Medicare NSC