Provider Demographics
NPI:1669728762
Name:ANGISA MEDICAL SUPPLIES CORP
Entity type:Organization
Organization Name:ANGISA MEDICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:OLABANJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-614-3119
Mailing Address - Street 1:20915 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1548
Mailing Address - Country:US
Mailing Address - Phone:718-614-3119
Mailing Address - Fax:
Practice Address - Street 1:20915 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1548
Practice Address - Country:US
Practice Address - Phone:718-614-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies