1023062361 NPI number — G E DIABETIC SUUPLY, INC

Table of content: MS. DONNA LYNNE HUNSTOCK LPC (NPI 1104832914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023062361 NPI number — G E DIABETIC SUUPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G E DIABETIC SUUPLY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023062361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
810 SE 8TH AVENUE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
DEERFIELD BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33441-5623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-210-5625
Provider Business Mailing Address Fax Number:
561-210-7452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
810 SE 8TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DEERFIELD BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33441-5623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-210-5625
Provider Business Practice Location Address Fax Number:
561-210-7452
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OHAYON
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-210-5625

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)