# QUEENS MEDICAL SUPPLY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497299929
- **Authorized official:** KENNETH LEE DOR (OWNER)
- **Authorized official phone:** (954) 289-2169

## Contact information

- **Practice address:** 16772 NE 5TH AVE, N MIAMI BEACH, FL 33162-3928
- **Practice address phone:** (954) 289-2169
- **Mailing address:** 16772 NE 5TH AVE, N MIAMI BEACH, FL 33162-3928
- **Mailing address phone:** (954) 289-2169

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 12/19/2016
- **Last updated:** 02/18/2019