| NPI | 1104118504 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALIEASE MICHELLE SIMMONS Owner 917-715-7972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2011-05-04 |