Provider Demographics
NPI:1346394145
Name:SYSTIK MEDICAL, INC.
Entity Type:Organization
Organization Name:SYSTIK MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORACCHIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-765-3100
Mailing Address - Street 1:3920 CYPRESS DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5694
Mailing Address - Country:US
Mailing Address - Phone:707-765-3141
Mailing Address - Fax:707-776-2682
Practice Address - Street 1:3920 CYPRESS DR
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5694
Practice Address - Country:US
Practice Address - Phone:707-765-3141
Practice Address - Fax:707-776-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASRJH99159048332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies