Healthcare Provider Details

I. General information

NPI: 1083982490
Provider Name (Legal Business Name): PASSAIC HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2011
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 COLUMBUS AVE
NEW ROCHELLE NY
10801-6922
US

IV. Provider business mailing address

125 NEWTOWN RD SUITE 300
PLAINVIEW NY
11803-4314
US

V. Phone/Fax

Practice location:
  • Phone: 800-244-4660
  • Fax: 866-511-0294
Mailing address:
  • Phone: 800-244-4660
  • Fax: 866-511-0294

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 Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: WINTHROP HAYES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 800-244-4660