Provider Demographics
NPI:1154528180
Name:A-1 SURGICAL AND MEDICAL SUPPLIES INC
Entity type:Organization
Organization Name:A-1 SURGICAL AND MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ORTHOTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:CORSENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:BOARD CERTIFIED ORTH
Authorized Official - Phone:516-292-4105
Mailing Address - Street 1:30 E JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3123
Mailing Address - Country:US
Mailing Address - Phone:516-741-1087
Mailing Address - Fax:516-873-7904
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4051
Practice Address - Country:US
Practice Address - Phone:516-292-4105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222Z00000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02917357Medicaid
NY02917357Medicaid