Provider Demographics
NPI:1487929535
Name:BRAND MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:BRAND MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISHO
Authorized Official - Middle Name:
Authorized Official - Last Name:FATTAHOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-381-4700
Mailing Address - Street 1:6637 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7055
Mailing Address - Country:US
Mailing Address - Phone:718-381-4700
Mailing Address - Fax:718-381-0700
Practice Address - Street 1:6637 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7055
Practice Address - Country:US
Practice Address - Phone:718-381-4700
Practice Address - Fax:718-381-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1302827332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies