Healthcare Provider Details

I. General information

NPI: 1245571330
Provider Name (Legal Business Name): NATES HEALTHCARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BROADWAY
STATEN ISLAND NY
10310-2803
US

IV. Provider business mailing address

516 BROADWAY
STATEN ISLAND NY
10310-2804
US

V. Phone/Fax

Practice location:
  • Phone: 718-720-3710
  • Fax: 718-720-6135
Mailing address:
  • Phone: 718-720-3710
  • Fax: 718-720-6135

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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. BORIS NATENZON
Title or Position: PRESIDENT
Credential:
Phone: 917-734-4662