Provider Demographics
NPI:1184131575
Name:MYRTLE DME NYC INC
Entity type:Organization
Organization Name:MYRTLE DME NYC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EFRAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-864-3311
Mailing Address - Street 1:11611 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11611 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1744
Practice Address - Country:US
Practice Address - Phone:347-514-9118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-07
Last Update Date:2018-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies