1437351384 NPI number — NEW YORK DIABETIC SUPPLY

Table of content: (NPI 1437351384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437351384 NPI number — NEW YORK DIABETIC SUPPLY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK DIABETIC SUPPLY
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:
NEIGHBORHOOD DIABETES
Provider Other Organization Name Type Code:
3
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:
1437351384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 849098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-9098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-853-9349
Provider Business Mailing Address Fax Number:
718-972-7895

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
958 - E 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
11230-2610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-853-9349
Provider Business Practice Location Address Fax Number:
866-784-5646
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CASS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
JAROD
Authorized Official Title or Position:
VICE PRESIDENT AND GENERAL MANAGER
Authorized Official Telephone Number:
978-600-7445

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X , with the licence number:  14490 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00262506 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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