Healthcare Provider Details

I. General information

NPI: 1841281045
Provider Name (Legal Business Name): MEDI-FAIR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JEFFERSON ST
MONTICELLO NY
12701-1161
US

IV. Provider business mailing address

25 JEFFERSON ST
MONTICELLO NY
12701-1161
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-2323
  • Fax: 845-794-0712
Mailing address:
  • Phone: 845-794-2323
  • Fax: 845-794-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARILYN GITLIN
Title or Position: CEO
Credential:
Phone: 845-794-2323