Provider Demographics
NPI: | 1235520271 |
---|---|
Name: | ALLIED MEDICAL AND DIAGNOSTIC SERVICES, DISPENSARY |
Entity Type: | Organization |
Organization Name: | ALLIED MEDICAL AND DIAGNOSTIC SERVICES, DISPENSARY |
Other - Org Name: | ALLIED MEDICAL AND DIAGNOSTIC SERVICES, DISPENSARY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ACCOUNT MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SARAH |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DOBSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 646-576-8705 |
Mailing Address - Street 1: | 1410 BROADWAY, 23RD FLOOR |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10018 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-575-2898 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1410 BROADWAY, 23RD FLOOR |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10018 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-575-2898 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-02-12 |
Last Update Date: | 2015-02-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332900000X | Suppliers | Non-Pharmacy Dispensing Site |