Provider Demographics
NPI:1023148129
Name:CITY MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:CITY MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PIUS
Authorized Official - Middle Name:O
Authorized Official - Last Name:OVIAWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-684-4474
Mailing Address - Street 1:3251 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456
Mailing Address - Country:US
Mailing Address - Phone:718-684-4474
Mailing Address - Fax:718-684-4533
Practice Address - Street 1:3251 3RD AVE
Practice Address - Street 2:BY 163RD ST / 3RD FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6832
Practice Address - Country:US
Practice Address - Phone:718-684-4474
Practice Address - Fax:718-684-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies