Provider Demographics
NPI:1679224323
Name:BLUE MEDICAL SUPPLY CORPORATION
Entity type:Organization
Organization Name:BLUE MEDICAL SUPPLY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BAHLOOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD/MBA
Authorized Official - Phone:347-806-6678
Mailing Address - Street 1:6917 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1501
Mailing Address - Country:US
Mailing Address - Phone:347-806-6678
Mailing Address - Fax:
Practice Address - Street 1:6917 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1501
Practice Address - Country:US
Practice Address - Phone:347-806-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies