Provider Demographics
NPI:1902025604
Name:ALL CARE MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ALL CARE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OFELIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILISHAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-859-3493
Mailing Address - Street 1:1213 FOSTER AVE # 1215
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-1607
Mailing Address - Country:US
Mailing Address - Phone:718-859-3493
Mailing Address - Fax:718-859-3495
Practice Address - Street 1:1213 FOSTER AVE # 1215
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-1607
Practice Address - Country:US
Practice Address - Phone:718-859-3493
Practice Address - Fax:718-859-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02842280Medicaid
NY02842280Medicaid