MEDICARE: SUBURBAN HEALTH SERVICES INC

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
2	3336C0003X	Community/Retail Pharmacy
3	3336S0011X	Specialty Pharmacy	012248	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3341637	OTHER		OTHER ID NUMBER

General Provider Information

NPI Number	:	1639260839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	430 S MAIN ST
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 S MAIN ST
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-2844
Country	:	US
Telephone Number	:	315-458-1231
Fax Number	:	315-458-8558

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	HOWARD SCHWARTZ
Credential	:
Telephone Number	:	315-458-1231

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	09/13/2007

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