Provider Demographics
NPI:1942743190
Name:SANDRA MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:SANDRA MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-492-7717
Mailing Address - Street 1:2177 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-6002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2177 72ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-6002
Practice Address - Country:US
Practice Address - Phone:347-492-7717
Practice Address - Fax:347-492-7718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04862979Medicaid