Provider Demographics
NPI:1083322960
Name:AUTOREFILLIT LLC
Entity Type:Organization
Organization Name:AUTOREFILLIT LLC
Other - Org Name:GO PLAY USA INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-623-8389
Mailing Address - Street 1:4520 12THV AVENUE
Mailing Address - Street 2:APT A5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2010
Mailing Address - Country:US
Mailing Address - Phone:845-587-1868
Mailing Address - Fax:
Practice Address - Street 1:3611 14TH AVE STE 388
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3750
Practice Address - Country:US
Practice Address - Phone:646-813-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY801059134Medicaid