Provider Demographics
NPI:1356312748
Name:SUBURBAN OXYGEN SUPPLY INC.
Entity Type:Organization
Organization Name:SUBURBAN OXYGEN SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMEESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-691-8595
Mailing Address - Street 1:180 IRWIN RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2211
Mailing Address - Country:US
Mailing Address - Phone:716-691-8595
Mailing Address - Fax:716-691-8561
Practice Address - Street 1:180 IRWIN RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2211
Practice Address - Country:US
Practice Address - Phone:716-691-8595
Practice Address - Fax:716-691-8561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0178300001Medicare NSC