Provider Demographics
NPI:1003033887
Name:MODIFICATIONS & EQUIPMENT FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:MODIFICATIONS & EQUIPMENT FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LEMNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-279-0888
Mailing Address - Street 1:339 SMITH HILL RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8985
Mailing Address - Country:US
Mailing Address - Phone:518-279-0888
Mailing Address - Fax:518-279-1560
Practice Address - Street 1:339 SMITH HILL RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8985
Practice Address - Country:US
Practice Address - Phone:518-279-0888
Practice Address - Fax:518-279-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01884220OtherTBI
NY01807845Medicaid
NY01884220Medicaid
NY10070305OtherHMO DME PROVIDER
NY000402661000OtherHMO DME PROVIDER
NY01884220OtherTBI