Provider Demographics
NPI:1609055888
Name:NY ADVANCED MEDICAL PRODUCTS, LLC
Entity type:Organization
Organization Name:NY ADVANCED MEDICAL PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-872-3100
Mailing Address - Street 1:125 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3822
Mailing Address - Country:US
Mailing Address - Phone:516-872-3100
Mailing Address - Fax:516-568-0876
Practice Address - Street 1:125 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3822
Practice Address - Country:US
Practice Address - Phone:516-872-3250
Practice Address - Fax:516-568-0876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6063530002Medicare NSC