Provider Demographics
NPI:1063129591
Name:MOBILE MEDICAL SUPPLIES & SERVICES INC
Entity type:Organization
Organization Name:MOBILE MEDICAL SUPPLIES & SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-750-3357
Mailing Address - Street 1:14430 157TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4254
Mailing Address - Country:US
Mailing Address - Phone:718-750-3357
Mailing Address - Fax:718-306-6010
Practice Address - Street 1:14430 157TH ST STE 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-4254
Practice Address - Country:US
Practice Address - Phone:718-750-3357
Practice Address - Fax:718-306-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies