Provider Demographics
NPI:1316127343
Name:JULIA'S PHENIKS MEDICAL SUPPLY
Entity type:Organization
Organization Name:JULIA'S PHENIKS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZINOVY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-724-1687
Mailing Address - Street 1:4 MARION CT
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2634
Mailing Address - Country:US
Mailing Address - Phone:646-724-1687
Mailing Address - Fax:646-724-1687
Practice Address - Street 1:4 MARION CT
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2634
Practice Address - Country:US
Practice Address - Phone:646-724-1687
Practice Address - Fax:646-724-1687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4314880001Medicare NSC