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General NPI Number Information
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NPI Number | 1750503298
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Entity Type | Organization
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Legal Business Name | IMADULATION INTERNATIONAL, LP
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2007 N COLLINS BLVD #509A
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City | RICHARDSON
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State | TX
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Zip | 75080-2658
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Country | US
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Telephone | 972-880-0102
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Fax |
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Provider Business Mailing Address
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Address Line | 7201 CUTTER MILL DR
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City | DALLAS
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State | TX
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Zip | 75248
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Country | US
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Telephone | 972-880-0102
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELLEN CHERNOFF SIMON
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Credential | LPC
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Telephone | 972-880-0102
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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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