Organization
INNOVATIVE MEDICAL SUPPLY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIDAL LEROY IRABOR (PRESIDENT)
(347) 204-5623
Entity
Organization
Contact information
Practice address
8306 FLATLANDS AVE, BROOKLYN, NY 11236-3506
(347) 562-3046
(347) 713-5334
Mailing address
8306 FLATLANDS AVE, BROOKLYN, NY 11236-3506
(347) 562-3046
(347) 713-5334
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
NY
Other
Enumeration date
11/15/2011
Last updated
11/15/2011
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