Healthcare Provider Details

I. General information

NPI: 1073994935
Provider Name (Legal Business Name): RECOIL SPINAL SYSTEMS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 JEFFREY BLVD SUITE 3
BUFFALO NY
14219-2338
US

IV. Provider business mailing address

4090 JEFFREY BLVD SUITE 3
BUFFALO NY
14219-2338
US

V. Phone/Fax

Practice location:
  • Phone: 844-473-2645
  • Fax:
Mailing address:
  • Phone: 844-473-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberC17849
License Number StateMD

VIII. Authorized Official

Name: CASSANDRA R SMITH-ROSS
Title or Position: CRENTIALING SPECIALIST
Credential:
Phone: 920-858-4533