=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336681790
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN CARPARELLI
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2016
-----------------------------------------------------
Last Update Date | 01/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18 JAMES ST S SUITE 100
-----------------------------------------------------
City | EAST ROCKAWAY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11518-2017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-879-5226
-----------------------------------------------------
Fax | 516-874-2763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 570 BELLMORE RD
-----------------------------------------------------
City | EAST MEADOW
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11554-5456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-456-2467
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. JOHN MICHAEL CARPARELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-456-2467
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------