1972741825 NPI number — SUNNYSIDE RESPIRATORY CARE INC

Table of content: (NPI 1972741825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972741825 NPI number — SUNNYSIDE RESPIRATORY CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNNYSIDE RESPIRATORY CARE 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:
SUNNYSIDE DIABETICS
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:
1972741825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9045 LAFONTANA BLVD
Provider Second Line Business Mailing Address:
206
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33434-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-488-4450
Provider Business Mailing Address Fax Number:
561-488-4451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9045 LAFONTANA BLVD
Provider Second Line Business Practice Location Address:
206
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33434-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-488-4450
Provider Business Practice Location Address Fax Number:
561-488-4451
Provider Enumeration Date:
01/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JACOBSON
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-488-4450

Provider Taxonomy Codes

  • Taxonomy code: 3336M0002X , with the licence number:  1313310 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1041968 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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