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General NPI Number Information
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NPI Number | 1043275969
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Entity Type | Organization
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Legal Business Name | OPTUM INFUSION SERVICES 100, INC.
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 931 D CONKLIN STREET
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City | FARMINGDALE
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State | NY
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Zip | 11735
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Country | US
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Telephone | 800-346-6348
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Fax | 866-689-3569
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Provider Business Mailing Address
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Address Line | 931 D CONKLIN STREET
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City | FARMINGDALE
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State | NY
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Zip | 11735
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Country | US
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Telephone | 800-346-6348
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Fax | 866-689-3569
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Authorized Official
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Title or Position | VP, COMPLIANCE
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Name | DAVID OBERG
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Credential |
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Telephone | 499-988-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 020477
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251F00000X
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Taxonomy Name | Home Infusion Agency
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License Number | 9296L0001
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License Number State | NY
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