Provider Demographics
NPI:1386028546
Name:RLN ENTERPRISES, INC
Entity Type:Organization
Organization Name:RLN ENTERPRISES, INC
Other - Org Name:EASTSIDE MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:NETTNIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-227-8750
Mailing Address - Street 1:2210 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2436
Mailing Address - Country:US
Mailing Address - Phone:585-227-8750
Mailing Address - Fax:585-227-8563
Practice Address - Street 1:2210 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2436
Practice Address - Country:US
Practice Address - Phone:585-227-8750
Practice Address - Fax:585-227-8563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RLN ENTERPRISES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5083030001Medicaid
NY5083030001Medicaid