1184650780 NPI number — MEDICAL & DIABETIC SUPPLIES, INC.

Table of content: (NPI 1184650780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184650780 NPI number — MEDICAL & DIABETIC SUPPLIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL & DIABETIC SUPPLIES, 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:
1184650780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
197 HAMPTON CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-8145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-745-9167
Provider Business Mailing Address Fax Number:
561-747-4647

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1829 PARK LN S
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-8086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-745-9167
Provider Business Practice Location Address Fax Number:
561-747-4647
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PENCHANSKY
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-745-9167

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  4560810001 , 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)





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