Central Avenue Medical & Surgical Supply, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

5670410001 Issued in NY

Legal business name

CENTRAL AVENUE MEDICAL & SURGICAL SUPPLY, INC.

Practice address

339 Central Ave
Lawrence, NY 11559-1605

Phone

(516) 374-4401

Fax

(516) 374-3142

NPI assigned

Jul 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Henya Wieder

Title

President

Phone

(516) 374-4401

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1366461584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "339 CENTRAL AVE",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591605",
            "telephone_number": "516-374-4401",
            "fax_number": "516-374-3142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "339 CENTRAL AVE",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591605",
            "telephone_number": "516-374-4401",
            "fax_number": "516-374-3142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL AVENUE MEDICAL & SURGICAL SUPPLY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIEDER",
        "authorized_official_first_name": "HENYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-374-4401",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NY",
            "license": "5670410001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.