Provider Demographics
NPI: | 1164729323 |
---|---|
Name: | NIVRAM MANAGEMENT, INC. |
Entity Type: | Organization |
Organization Name: | NIVRAM MANAGEMENT, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MARVIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MERMELSTEIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 847-679-7484 |
Mailing Address - Street 1: | 6500 N HAMLIN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | LINCOLNWOOD |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60712-3904 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-679-7484 |
Mailing Address - Fax: | 847-679-7494 |
Practice Address - Street 1: | 6500 N HAMLIN AVE |
Practice Address - Street 2: | |
Practice Address - City: | LINCOLNWOOD |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60712-3904 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-679-7484 |
Practice Address - Fax: | 847-679-7494 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-02-23 |
Last Update Date: | 2013-06-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | =========801 | Medicaid |