Provider Demographics
NPI:1922440882
Name:FREEDOM STAR MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:FREEDOM STAR MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISHI
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLENIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-513-5118
Mailing Address - Street 1:6111 MENAHAN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2627
Mailing Address - Country:US
Mailing Address - Phone:516-513-5118
Mailing Address - Fax:
Practice Address - Street 1:6111 MENAHAN ST
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2627
Practice Address - Country:US
Practice Address - Phone:516-513-5118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-20
Last Update Date:2013-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies