Provider Demographics
NPI:1023383908
Name:CROWN MEDICAL SUPPLY
Entity type:Organization
Organization Name:CROWN MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADENIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-288-7670
Mailing Address - Street 1:1162 SAINT JOHNS PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2898
Mailing Address - Country:US
Mailing Address - Phone:646-288-7670
Mailing Address - Fax:
Practice Address - Street 1:1162 SAINT JOHNS PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-2898
Practice Address - Country:US
Practice Address - Phone:646-288-7670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies