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General NPI Number Information
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NPI Number | 1063377109
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Entity Type | Organization
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Legal Business Name | MOTHER GOOSE MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 12/22/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 720 N MAIN ST
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-1665
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Country | US
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Telephone | 315-385-7011
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Fax | 315-410-5376
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Provider Business Mailing Address
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Address Line | 720 N MAIN ST
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-1665
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Country | US
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Telephone | 315-385-7011
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Fax | 315-410-5376
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Authorized Official
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Title or Position | CEO
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Name | MARIE FIELDS-EALEY
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Credential |
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Telephone | 315-708-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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