MEDICARE: LIFELINE MEDICAL CORP.

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

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

General Provider Information

NPI Number	:	1821027681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFELINE MEDICAL CORP.

Provider Business Mailing Address
First Line	:	6821 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5856
Country	:	US
Telephone Number	:	718-621-2250
Fax Number	:	718-621-2250

Provider Business Practice Location Address
First Line	:	6821 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-5856
Country	:	US
Telephone Number	:	718-621-2250
Fax Number	:	718-621-2250

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ARTHUR BOLBIRER
Credential	:
Telephone Number	:	718-621-2250

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	01/28/2008

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