Provider Demographics
NPI:1902309644
Name:PRIME HEALTH MEDICAL SUPPLIES
Entity Type:Organization
Organization Name:PRIME HEALTH MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPS MRG
Authorized Official - Prefix:
Authorized Official - First Name:ELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUBAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-446-2300
Mailing Address - Street 1:8916 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7857
Mailing Address - Country:US
Mailing Address - Phone:718-446-2300
Mailing Address - Fax:718-446-2303
Practice Address - Street 1:8916 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7857
Practice Address - Country:US
Practice Address - Phone:718-446-2300
Practice Address - Fax:718-446-2303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition