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General NPI Number Information
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NPI Number | 1629226048
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Entity Type | Organization
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Legal Business Name | THERA-DIAGNOSTICS AND MEDICAL SUPPLIES, INC.
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Dates
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Enumeration Date | 08/28/2008
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Last Update Date | 08/28/2008
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Provider Practice Location Address
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Address Line | 17555 COLLINS AVE
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-2882
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Country | US
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Telephone | 786-525-8167
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Fax | 954-983-1929
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Provider Business Mailing Address
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Address Line | 17555 COLLINS AVE
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160-2882
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Country | US
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Telephone | 786-525-8167
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Fax | 954-983-1929
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. HAROLD HIRSCHENSON
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Credential |
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Telephone | 786-525-8167
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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 | P94000059383
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License Number State | FL
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