Provider Demographics
NPI:1023589363
Name:PRIMETIME MEDICAL SUPPLY INC.
Entity type:Organization
Organization Name:PRIMETIME MEDICAL SUPPLY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:OLATUNDE-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-685-6343
Mailing Address - Street 1:671 LIBERTY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-3292
Mailing Address - Country:US
Mailing Address - Phone:718-975-3690
Mailing Address - Fax:718-975-3689
Practice Address - Street 1:671 LIBERTY AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3292
Practice Address - Country:US
Practice Address - Phone:718-975-3690
Practice Address - Fax:718-975-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies