MEDICARE: FUNCTIONAL DME, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1487027553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL DME, LLC

Provider Business Mailing Address
First Line	:	22 KENDRICK HILL RD
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6807
Country	:	US
Telephone Number	:	212-354-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	22 KENDRICK HILL RD
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-6807
Country	:	US
Telephone Number	:	212-354-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. AATIF SIDDIQUI
Credential	:
Telephone Number	:	646-823-4034

Provider Enumeration Date	:	11/11/2015
Last Update Date	:	11/11/2015

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