Healthcare Provider Details

I. General information

NPI: 1821129628
Provider Name (Legal Business Name): NORTHEAST HOME MEDICAL SUPPLIES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N LINCOLN DR
CAIRO NY
12413-2606
US

IV. Provider business mailing address

15 N LINCOLN DR
CAIRO NY
12413-2606
US

V. Phone/Fax

Practice location:
  • Phone: 518-622-8108
  • Fax: 518-966-4813
Mailing address:
  • Phone: 518-622-8108
  • Fax: 518-966-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT A VINELLI
Title or Position: PRESIDENT
Credential:
Phone: 518-622-8108