Provider Demographics
NPI:1184703936
Name:CROSS LINE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:CROSS LINE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-582-8800
Mailing Address - Street 1:PO BOX 11214
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-0955
Mailing Address - Country:US
Mailing Address - Phone:631-582-8800
Mailing Address - Fax:
Practice Address - Street 1:103 BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-5207
Practice Address - Country:US
Practice Address - Phone:631-582-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1201600001Medicare NSC