MEDICARE: LONG ISLAND RESPIRATORY 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		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

General Provider Information

NPI Number	:	1922115690
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG ISLAND RESPIRATORY SERVICES, INC.

Provider Business Mailing Address
First Line	:	122 MILL RD
Second Line	:	SUITE A130
City	:	PHOENIXVILLE
State	:	PA
Zip	:	19460-1413
Country	:	US
Telephone Number	:	610-630-6357
Fax Number	:	610-630-8319

Provider Business Practice Location Address
First Line	:	1685 E 21ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-5037
Country	:	US
Telephone Number	:	516-764-3856
Fax Number	:	516-764-3859

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN M. GVODAS JR.
Credential	:
Telephone Number	:	610-630-6357

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	04/29/2015

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