Provider Demographics
NPI:1972849305
Name:MOUNT OLIVE DME, LLC
Entity Type:Organization
Organization Name:MOUNT OLIVE DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MIZRAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-487-5044
Mailing Address - Street 1:68 HAWTHORNE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5763
Mailing Address - Country:US
Mailing Address - Phone:516-487-5044
Mailing Address - Fax:516-487-5043
Practice Address - Street 1:68 HAWTHORNE ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5763
Practice Address - Country:US
Practice Address - Phone:516-487-5044
Practice Address - Fax:516-487-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies