MEDICARE: NEIGHBORHOOD DIABETES, 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	332B00000X	Durable Medical Equipment & Medical Supplies		FL

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	:	1871759118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIGHBORHOOD DIABETES, INC.

Provider Business Mailing Address
First Line	:	8881 S US HIGHWAY 1
Second Line	:	ATTN: LICENSING DEPARTMENT
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3401
Country	:	US
Telephone Number	:	772-398-2122
Fax Number	:	844-363-4341

Provider Business Practice Location Address
First Line	:	5976 HOFFNER AVENUE
Second Line	:	SUITE 607
City	:	ORLANDO
State	:	FL
Zip	:	32822-4821
Country	:	US
Telephone Number	:	866-784-5647
Fax Number	:	844-363-4341

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONATHAN BLACK
Credential	:
Telephone Number	:	772-398-2122

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	07/29/2016

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Directions to “NEIGHBORHOOD DIABETES, INC. ” Practice Location

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