MEDICARE: 4 LAFAYETTE COURT 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	:	1952743130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	4 LAFAYETTE COURT LLC

Provider Business Mailing Address
First Line	:	PO BOX 363
Second Line	:
City	:	TENAFLY
State	:	NJ
Zip	:	07670-0363
Country	:	US
Telephone Number	:	201-914-7624
Fax Number	:	201-983-4223

Provider Business Practice Location Address
First Line	:	4 LAFAYETTE CT
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-3036
Country	:	US
Telephone Number	:	201-914-7624
Fax Number	:	732-416-9436

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. MERRI SILVERSTEIN
Credential	:
Telephone Number	:	201-914-7624

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	05/02/2014

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