Provider Demographics
NPI:1942284773
Name:FREEDOM MEDICAL SUPPLIES INC.
Entity Type:Organization
Organization Name:FREEDOM MEDICAL SUPPLIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-264-2388
Mailing Address - Street 1:201B BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2750
Mailing Address - Country:US
Mailing Address - Phone:631-264-2388
Mailing Address - Fax:631-264-2389
Practice Address - Street 1:201B BROADWAY
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2750
Practice Address - Country:US
Practice Address - Phone:631-264-2388
Practice Address - Fax:631-264-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02381895Medicaid
NY4628480001Medicare NSC