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General NPI Number Information
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NPI Number | 1457413155
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Entity Type | Organization
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Legal Business Name | SUGARLESS SHOPPE, INC.
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 306 MAIN ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-3507
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Country | US
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Telephone | 631-773-5370
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Fax | 631-773-5369
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Provider Business Mailing Address
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Address Line | 306 MAIN ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-3507
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Country | US
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Telephone | 631-773-5370
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Fax | 631-773-5369
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. IRA WILLIAM SMALL
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Credential | DME
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Telephone | 631-773-5370
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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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