Provider Demographics
NPI:1154462562
Name:PULMONARY HOME CARE SERVICES OF LI, INC.
Entity Type:Organization
Organization Name:PULMONARY HOME CARE SERVICES OF LI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:J
Authorized Official - Last Name:DANIN
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:631-732-2753
Mailing Address - Street 1:58 WYANDOTTE ST
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-4028
Mailing Address - Country:US
Mailing Address - Phone:631-732-2753
Mailing Address - Fax:631-254-4536
Practice Address - Street 1:60 CORBIN AVE
Practice Address - Street 2:SUITE L
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-1046
Practice Address - Country:US
Practice Address - Phone:631-243-0033
Practice Address - Fax:631-254-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00930869Medicaid
NY00930869Medicaid