Provider Demographics
NPI:1699147546
Name:ADVENTURE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ADVENTURE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:TSVI
Authorized Official - Last Name:MITTELDORF
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, ATP
Authorized Official - Phone:718-564-6225
Mailing Address - Street 1:3507 AVE S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3454
Mailing Address - Country:US
Mailing Address - Phone:718-564-6225
Mailing Address - Fax:
Practice Address - Street 1:3507 AVE S
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3454
Practice Address - Country:US
Practice Address - Phone:718-564-6225
Practice Address - Fax:718-564-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies