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Organization
LIC COM, LLC
Active
Organization
LIC COM, LLC
Active
Other names
Kommissary
Organization subpart
No
Provider details
NPI number
Authorized official
ETHAN LEE (CFO)
(201) 556-8312
Entity
Organization
Contact information
Practice address
509 MANIDA ST, BRONX, NY 10474-6821
(888) 676-2892
(518) 797-6257
Mailing address
509 MANIDA ST, BRONX, NY 10474-6821
(888) 676-2892
(518) 797-6257
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
NULL
332U00000X
Home Delivered Meals
Primary
—
NULL
335G00000X
Medical Foods Supplier
—
NULL
Other
Enumeration date
01/13/2026
Last updated
01/22/2026
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