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General NPI Number Information
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NPI Number | 1720293335
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Entity Type | Organization
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Legal Business Name | BLUM'S CORSET SHOP OF PATCHOGUE, INC.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5110 MAIN ST SUITE 103
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5256
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Country | US
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Telephone | 716-633-8999
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Fax | 716-633-5144
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Provider Business Mailing Address
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Address Line | 5110 MAIN ST SUITE 103
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5256
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Country | US
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Telephone | 716-633-8999
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Fax | 716-633-5144
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC SIEGEL
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Credential |
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Telephone | 631-475-0136
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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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