Healthcare Provider Details

I. General information

NPI: 1760097000
Provider Name (Legal Business Name): ADVANCED EGRESS SOLUTIONS , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 PINETREE DR
SOUTH FARMINGDALE NY
11735-4436
US

IV. Provider business mailing address

PO BOX 33
BETHPAGE NY
11714-0033
US

V. Phone/Fax

Practice location:
  • Phone: 516-359-8521
  • Fax: 516-420-4104
Mailing address:
  • Phone: 516-359-8521
  • Fax: 516-420-4104

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: LYNN MOLONEY
Title or Position: PRESIDENT
Credential:
Phone: 516-359-8521