Basic Information
| Provider Information | |||||||||
| NPI: | 1881887107 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN SURGICAL SUPPLY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108015214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146373510 | ||||||||
| FaxNumber: | 9148190061 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 COMMERCE DR | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108015214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146373510 | ||||||||
| FaxNumber: | 9148190061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 08/21/2007 | ||||||||
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| AuthorizedOfficialLastName: | KOCH | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT & CEO | ||||||||
| AuthorizedOfficialTelephone: | 9146373511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 192817 | NY | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 192817 | 01 | NY | DR. KOCH - STATE LICENSE# | OTHER |