Provider Demographics
NPI:1922683069
Name:ICON MEDICAL SUPPLIES, LLC
Entity Type:Organization
Organization Name:ICON MEDICAL SUPPLIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PICARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-673-1984
Mailing Address - Street 1:182 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6987
Mailing Address - Country:US
Mailing Address - Phone:631-673-1984
Mailing Address - Fax:
Practice Address - Street 1:182 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6987
Practice Address - Country:US
Practice Address - Phone:631-673-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies