Myrtle Avenue Trading LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

2050808-DCA Issued in NY

Legal business name

MYRTLE AVENUE TRADING LLC

Practice address

7611 Myrtle Ave
Glendale, NY 11385-7446

Phone

(347) 384-2789

Fax

(646) 968-9971

NPI assigned

Jul 18, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Rakhmin Dekhkanov

Title

Member

Phone

(347) 384-2789

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1669995007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7611 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857446",
            "telephone_number": "347-384-2789",
            "fax_number": "646-968-9971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7611 MYRTLE AVE",
            "city": "GLENDALE",
            "state": "NY",
            "postal_code": "113857446",
            "telephone_number": "347-384-2789",
            "fax_number": "646-968-9971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE AVENUE TRADING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-18",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "DEKHKANOV",
        "authorized_official_first_name": "RAKHMIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "347-384-2789",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NY",
            "license": "2050808-DCA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Muras
• Mark G Musial, OPTHALMIC DISPENSER
• Mona Muzyk
• Agnieszka Muzyka, RN
• Myrtle Ave Medical PLLC
• Myrtle Express Pharmacy Inc
• Myrtle Meds Inc
• Myrtle Wellness Pharmacy Corp
• Nicole Nagib
• Michael Narine

• Customized Equipment (DME) in Glendale, NY
• Providers in Glendale, NY by specialty
• Customized Equipment (DME) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.