Provider Demographics
NPI:1457243503
Name:SOURCEMEDSUPPLY CORPORATION
Entity type:Organization
Organization Name:SOURCEMEDSUPPLY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZACHERY LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HYSONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-992-1576
Mailing Address - Street 1:82 AVENUE O 3R
Mailing Address - Street 2:MEDICALSUPPLYCORP@PROTON.ME
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:347-992-1576
Mailing Address - Fax:
Practice Address - Street 1:82 AVENUE O 3R
Practice Address - Street 2:MEDICALSUPPLYCORP@PROTON.ME
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:347-992-1576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies