Provider Demographics
NPI:1932964723
Name:IK MED SUPPLY INC
Entity Type:Organization
Organization Name:IK MED SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRAKLI
Authorized Official - Middle Name:
Authorized Official - Last Name:KADARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-472-7700
Mailing Address - Street 1:297 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1721
Mailing Address - Country:US
Mailing Address - Phone:917-472-7700
Mailing Address - Fax:212-547-3913
Practice Address - Street 1:297 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1721
Practice Address - Country:US
Practice Address - Phone:917-472-7700
Practice Address - Fax:212-547-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies