Provider Demographics
NPI:1780711358
Name:STAFF MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:STAFF MEDICAL SUPPLY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / SUPERVISING PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMBINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-774-3311
Mailing Address - Street 1:PO BOX 250845
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-0845
Mailing Address - Country:US
Mailing Address - Phone:718-774-3311
Mailing Address - Fax:718-467-0741
Practice Address - Street 1:327 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-3514
Practice Address - Country:US
Practice Address - Phone:718-774-3311
Practice Address - Fax:718-467-0741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00323262Medicaid