MEDICARE: INNOVATIVE 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	251F00000X	Home Infusion Agency
2	251J00000X	Nursing Care Agency
3	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
4	332BX2000X	Oxygen Equipment & Supplies (DME)
5	333600000X	Pharmacy	028984	NY
6	3336S0011X	Specialty Pharmacy
7	3336H0001X	Home Infusion Therapy Pharmacy	028984	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	0701L003	OTHER	NY	DOH LICENSE
3	3358771	OTHER	NY	NCPDP
4	AAHD	OTHER	NY	MCD ETIN
5	028984	OTHER	NY	PHARMACY LICENSE
6	6853	OTHER	NY	MCD PIN

General Provider Information

NPI Number	:	1992750913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNOVATIVE SERVICES INC

Provider Business Mailing Address
First Line	:	7506 STATE ROUTE 5
Second Line	:	PO BOX 325
City	:	CLINTON
State	:	NY
Zip	:	13323-3654
Country	:	US
Telephone Number	:	315-853-1280
Fax Number	:	315-853-1285

Provider Business Practice Location Address
First Line	:	200 AIRPARK DR
Second Line	:	SUITE 100
City	:	ROCHESTER
State	:	NY
Zip	:	14624-5716
Country	:	US
Telephone Number	:	585-328-2050
Fax Number	:	585-394-2058

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. EDWARD P KRAMM
Credential	:
Telephone Number	:	913-515-6719

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	06/26/2025

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Directions to “INNOVATIVE SERVICES INC ” Practice Location

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