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General NPI Number Information
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NPI Number | 1255672168
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Entity Type | Organization
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Legal Business Name | NOVA INFUSION SERVICES INC
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Dates
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Enumeration Date | 03/04/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 913 OLD LIVERPOOL RD SUITE 1H
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City | LIVERPOOL
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State | NY
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Zip | 13088-5571
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Country | US
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Telephone | 315-299-8979
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Fax | 315-214-8377
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Provider Business Mailing Address
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Address Line | 913 OLD LIVERPOOL RD SUITE 1H
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City | LIVERPOOL
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State | NY
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Zip | 13088-5571
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Country | US
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Telephone | 315-299-8979
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Fax | 315-214-8377
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Authorized Official
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Title or Position | OWNER
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Name | TIM BRONCHETTI
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Credential |
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Telephone | 315-299-8979
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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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Taxonomy #2
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Taxonomy Code | 3336H0001X
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Taxonomy Name | Home Infusion Therapy Pharmacy
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License Number | 032350
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License Number State | NY
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