Provider Demographics
NPI:1841304698
Name:ASTORIA SURGICAL SUPPLIES CORP
Entity type:Organization
Organization Name:ASTORIA SURGICAL SUPPLIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:AVERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-436-3726
Mailing Address - Street 1:3104 60TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1221
Mailing Address - Country:US
Mailing Address - Phone:718-204-0816
Mailing Address - Fax:718-274-8525
Practice Address - Street 1:3104 60TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1221
Practice Address - Country:US
Practice Address - Phone:718-204-0816
Practice Address - Fax:718-274-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0934999332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01669718Medicaid
NY01669718Medicaid