Provider Demographics
NPI:1255672168
Name:NOVA INFUSION SERVICES INC
Entity Type:Organization
Organization Name:NOVA INFUSION SERVICES INC
Other - Org Name:NOVA-INFUSION SERVICES INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONCHETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-299-8979
Mailing Address - Street 1:913 OLD LIVERPOOL RD
Mailing Address - Street 2:SUITE 1H
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5571
Mailing Address - Country:US
Mailing Address - Phone:315-299-8979
Mailing Address - Fax:315-214-8377
Practice Address - Street 1:913 OLD LIVERPOOL RD
Practice Address - Street 2:SUITE 1H
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5571
Practice Address - Country:US
Practice Address - Phone:315-299-8979
Practice Address - Fax:315-214-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
NY0323503336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143006OtherPK