Provider Demographics
NPI:1194894378
Name:LONG BEACH SURGICAL SUPPLY COMPANY
Entity type:Organization
Organization Name:LONG BEACH SURGICAL SUPPLY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHONFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-431-0617
Mailing Address - Street 1:259 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3222
Mailing Address - Country:US
Mailing Address - Phone:516-431-0617
Mailing Address - Fax:516-431-0784
Practice Address - Street 1:259 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3222
Practice Address - Country:US
Practice Address - Phone:516-431-0617
Practice Address - Fax:516-431-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00320585Medicaid
NY0145330001Medicare ID - Type Unspecified