Healthcare Provider Details

I. General information

NPI: 1992708283
Provider Name (Legal Business Name): NEIGHBORHOOD DIABETES NY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SUNRISE HIGHWAY SUITE D116
GREAT RIVER NY
11739-3500
US

IV. Provider business mailing address

3500 SUNRISE HIGHWAY SUITE D116
GREAT RIVER NY
11739-3500
US

V. Phone/Fax

Practice location:
  • Phone: 631-961-9954
  • Fax: 631-961-9899
Mailing address:
  • Phone: 631-961-9954
  • Fax: 631-961-9899

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: MS. KATHLEEN A BELMONTE
Title or Position: VICE PRESIDENT, CLINICAL SERVICES
Credential: MS, RN-CS
Phone: 781-246-9302