Provider Demographics
NPI:1770808669
Name:TRIUMPH MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:TRIUMPH MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIJAH
Authorized Official - Middle Name:TOLU
Authorized Official - Last Name:OMOLADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-478-4451
Mailing Address - Street 1:317 CASTLE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-1642
Mailing Address - Country:US
Mailing Address - Phone:917-478-4451
Mailing Address - Fax:347-851-4454
Practice Address - Street 1:1506 CASTLE HILL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4210
Practice Address - Country:US
Practice Address - Phone:347-810-6787
Practice Address - Fax:347-810-6786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-02
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6467520001Medicare NSC