Healthcare Provider Details

I. General information

NPI: 1598040610
Provider Name (Legal Business Name): ADAPTIVEMALL.COM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 S 2ND ST
DOLGEVILLE NY
13329-1307
US

IV. Provider business mailing address

15 S 2ND ST
DOLGEVILLE NY
13329-1307
US

V. Phone/Fax

Practice location:
  • Phone: 800-371-2778
  • Fax:
Mailing address:
  • Phone: 800-371-2778
  • Fax:

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: PAMELA BERGERON
Title or Position: CONSUMER SALES MANAGER
Credential:
Phone: 800-371-2778