Provider Demographics
NPI:1922336171
Name:HEALING SURGICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:HEALING SURGICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-299-7755
Mailing Address - Street 1:2611 MILL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6418
Mailing Address - Country:US
Mailing Address - Phone:917-299-7755
Mailing Address - Fax:
Practice Address - Street 1:331 TOMPKINS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1505
Practice Address - Country:US
Practice Address - Phone:917-299-7755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1332948332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6487910001Medicare NSC