Provider Demographics
NPI:1386814028
Name:GREAT SHAPES OF ALBERTSON INC
Entity Type:Organization
Organization Name:GREAT SHAPES OF ALBERTSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-364-1222
Mailing Address - Street 1:190 MINEOLA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1953
Mailing Address - Country:US
Mailing Address - Phone:516-364-1222
Mailing Address - Fax:516-364-0822
Practice Address - Street 1:190 MINEOLA AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-1953
Practice Address - Country:US
Practice Address - Phone:516-364-1222
Practice Address - Fax:516-364-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0850010001Medicare NSC