Provider Demographics
NPI:1891713277
Name:LISAN MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:LISAN MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANKINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-530-1450
Mailing Address - Street 1:253 36TH ST
Mailing Address - Street 2:SUITE 1-10
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-2546
Mailing Address - Country:US
Mailing Address - Phone:718-530-1450
Mailing Address - Fax:718-280-1333
Practice Address - Street 1:253 36TH ST
Practice Address - Street 2:SUITE 1-10
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232-2546
Practice Address - Country:US
Practice Address - Phone:718-530-1450
Practice Address - Fax:718-280-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0984160332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2001294-DCAOtherNYC DEPARTMENT OF CONSUMER AFFAIRS
NY1298830001Medicare ID - Type Unspecified