Elite Medical Supply Group LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ELITE MEDICAL SUPPLY GROUP LLC

Practice address

1071 Brighton Beach Ave
Brooklyn, NY 11235-5602

Phone

(347) 414-5700

Fax

(347) 406-6100

NPI assigned

Aug 9, 2019

Organization subpart

Yes

Parent organization

ELITE MEDICAL SUPPLY GROUP LLCAs reported in NPPES

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

Authorized official

Name

Mike Kostylev

Title

President

Phone

(347) 414-5700

Specialties & licenses 1

Addresses

Other names 1

• Elite Medical Supply Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Part of

Elite Medical Supply Group LLC

Locations

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

{
    "created_epoch": "1565308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646524800000",
    "number": "1629623210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1071 BRIGHTON BEACH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355602",
            "telephone_number": "347-414-5700",
            "fax_number": "347-406-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 BRIGHTON BEACH AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112355602",
            "telephone_number": "347-414-5700",
            "fax_number": "347-406-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL SUPPLY GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELITE MEDICAL SUPPLY GROUP LLC",
        "enumeration_date": "2019-08-09",
        "last_updated": "2022-03-06",
        "certification_date": "2022-03-06",
        "status": "A",
        "authorized_official_last_name": "KOSTYLEV",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "347-414-5700"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elite Medical Supply",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.