Provider Demographics
NPI:1295502565
Name:LONG ISLAND MED SUPPLY LLC
Entity type:Organization
Organization Name:LONG ISLAND MED SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-297-0262
Mailing Address - Street 1:2639 MIDDLE COUNTRY RD # 2639-2
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-3669
Mailing Address - Country:US
Mailing Address - Phone:631-268-3570
Mailing Address - Fax:
Practice Address - Street 1:2639 MIDDLE COUNTRY RD # 2639-2
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3669
Practice Address - Country:US
Practice Address - Phone:631-268-3570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies