Provider Demographics
NPI:1740490424
Name:OXFORD DIABETIC SUPPLY
Entity type:Organization
Organization Name:OXFORD DIABETIC SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LETKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-559-0639
Mailing Address - Street 1:304 PARK AVE S
Mailing Address - Street 2:STE 218
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4301
Mailing Address - Country:US
Mailing Address - Phone:800-559-0639
Mailing Address - Fax:800-548-6484
Practice Address - Street 1:304 PARK AVE S
Practice Address - Street 2:STE 218
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:800-559-0639
Practice Address - Fax:800-548-6484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5442460001Medicare NSC