Provider Demographics
NPI:1427227560
Name:SUPPLY SOLUTIONS A DIVISION OF NORTHEAST MOBILITY CENTER
Entity Type:Organization
Organization Name:SUPPLY SOLUTIONS A DIVISION OF NORTHEAST MOBILITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-438-3646
Mailing Address - Street 1:115 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1407
Mailing Address - Country:US
Mailing Address - Phone:518-438-3646
Mailing Address - Fax:518-453-0919
Practice Address - Street 1:115 EVERETT RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1407
Practice Address - Country:US
Practice Address - Phone:518-438-3646
Practice Address - Fax:518-453-0919
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST MOBILITY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2022-07-21
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
NY02711975Medicaid
NY10062957OtherCDPHP
NY02711975Medicaid