1598705386 NPI number — EMPIRE HOME INFUSION SERVICE INC

Table of content: (NPI 1598705386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598705386 NPI number — EMPIRE HOME INFUSION SERVICE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMPIRE HOME INFUSION SERVICE 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:
1598705386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 BLACKSMITH DR
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MALTA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12020-4428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-899-8103
Provider Business Mailing Address Fax Number:
518-899-2968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 BLACKSMITH DR
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MALTA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-899-8103
Provider Business Practice Location Address Fax Number:
518-899-2968
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MAZZACCO
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VP/DIRECTOR
Authorized Official Telephone Number:
518-270-1310

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00042512001 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 38242 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040401000497 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: B1A15 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000388 . This is a "EMPIRE BC FACILITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3317028 . This is a "EPIC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10029567 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: CWW311 . This is a "EMPHC-DME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Y060817 . This is a "CHAMPUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000478012001 . This is a "BSNENY, SR BLUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01697465 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07794179 . This is a "GATEWAY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 991638 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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