Provider Demographics
NPI:1437351384
Name:NEW YORK DIABETIC SUPPLY
Entity Type:Organization
Organization Name:NEW YORK DIABETIC SUPPLY
Other - Org Name:NEIGHBORHOOD DIABETES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:JAROD
Authorized Official - Last Name:CASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-600-7445
Mailing Address - Street 1:P.O. BOX 849098
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-9098
Mailing Address - Country:US
Mailing Address - Phone:718-853-9349
Mailing Address - Fax:718-972-7895
Practice Address - Street 1:958 - E 2ND STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MA
Practice Address - Zip Code:11230-2610
Practice Address - Country:US
Practice Address - Phone:718-853-9349
Practice Address - Fax:866-784-5646
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INSULET CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-04
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144903336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00262506Medicaid