Basic Information
| Provider Information | |||||||||
| NPI: | 1578037602 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DURAMED INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 960 S BROADWAY STE 120 | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118015028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803658825 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 960 S BROADWAY STE 120 | ||||||||
| Address2: | |||||||||
| City: | HICKSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118015028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803658825 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2019 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | LOFREDO | ||||||||
| AuthorizedOfficialFirstName: | STACY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4803658825 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CANBIOLA INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.