Provider Demographics
NPI:1487732939
Name:ABC MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:ABC MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:BORISKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-221-5877
Mailing Address - Street 1:19 E NORTHWEST HWY
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60067-3500
Mailing Address - Country:US
Mailing Address - Phone:847-221-5877
Mailing Address - Fax:847-221-5876
Practice Address - Street 1:19 E NORTHWEST HWY
Practice Address - Street 2:SUITE 3C
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-3500
Practice Address - Country:US
Practice Address - Phone:847-221-5877
Practice Address - Fax:847-221-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000498332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL4799970002Medicare NSC