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General NPI Number Information
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NPI Number | 1750876033
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Entity Type | Organization
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Legal Business Name | JULIE L RIEDL INC
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 511 E GENESEE ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1524
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Country | US
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Telephone | 315-637-2307
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Fax | 315-637-2308
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Provider Business Mailing Address
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Address Line | 511 E GENESEE ST
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-1524
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Country | US
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Telephone | 315-637-2307
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Fax | 315-637-2308
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Authorized Official
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Title or Position | OWNER
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Name | JULIE L RIEDL
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Credential | LPN
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Telephone | 315-637-2307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number |
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License Number State | NY
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