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General NPI Number Information
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NPI Number | 1225670185
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Entity Type | Organization
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Legal Business Name | LAINE MEDICAL SUPPLIES LLC
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Dates
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Enumeration Date | 10/11/2019
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Last Update Date | 01/09/2020
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Provider Practice Location Address
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Address Line | 11317 COLFAX ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2218
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Country | US
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Telephone | 718-413-4722
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Fax | 718-228-9471
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Provider Business Mailing Address
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Address Line | 11317 COLFAX ST
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City | QUEENS VILLAGE
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State | NY
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Zip | 11429-2218
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Country | US
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Telephone | 718-413-4722
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Fax | 718-228-9471
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA LAINE
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Credential |
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Telephone | 718-413-4722
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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 |
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License Number State |
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