Healthcare Provider Details

I. General information

NPI: 1710816186
Provider Name (Legal Business Name): NORTHSTAR SUPPLY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2319 E GENESEE ST APT 2
SYRACUSE NY
13210-2221
US

IV. Provider business mailing address

2319 E GENESEE ST APT 2
SYRACUSE NY
13210-2221
US

V. Phone/Fax

Practice location:
  • Phone: 315-450-7503
  • Fax:
Mailing address:
  • Phone: 315-450-7503
  • Fax:

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: THARUN P BETHIREDDY
Title or Position: PRESIDENT
Credential:
Phone: 315-450-7503