Provider Demographics
NPI:1306922661
Name:HEALTH SERVICES MEDICAL SUPPLY, INC
Entity type:Organization
Organization Name:HEALTH SERVICES MEDICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:C PED, ROF
Authorized Official - Phone:718-333-0225
Mailing Address - Street 1:2108 B WEST 7 STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3754
Mailing Address - Country:US
Mailing Address - Phone:718-333-0225
Mailing Address - Fax:718-336-9218
Practice Address - Street 1:2108 W 7TH ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3754
Practice Address - Country:US
Practice Address - Phone:718-333-0225
Practice Address - Fax:718-336-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5583800001Medicare ID - Type Unspecified