Provider Demographics
NPI:1780490581
Name:HOLISTIC MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:HOLISTIC MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAVLUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARUFOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-339-7311
Mailing Address - Street 1:1170 PORT WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3025
Mailing Address - Country:US
Mailing Address - Phone:516-810-2633
Mailing Address - Fax:516-268-9679
Practice Address - Street 1:1170 PORT WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3025
Practice Address - Country:US
Practice Address - Phone:516-810-2633
Practice Address - Fax:516-268-9679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies