Provider Demographics
NPI:1154960003
Name:MK SUPPLY & TECH INC
Entity type:Organization
Organization Name:MK SUPPLY & TECH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATAYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-469-5875
Mailing Address - Street 1:PO BOX 825377
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5377
Mailing Address - Country:US
Mailing Address - Phone:201-469-5875
Mailing Address - Fax:
Practice Address - Street 1:188-02 64TH AVE APT 8I
Practice Address - Street 2:
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3809
Practice Address - Country:US
Practice Address - Phone:201-469-5875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-24
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies