Provider Demographics
NPI:1447787601
Name:LATITUDE NORTH CORPORATION
Entity Type:Organization
Organization Name:LATITUDE NORTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KALKOWSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-662-9012
Mailing Address - Street 1:333 LAS OLAS WAY APT 3504
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2392
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 LAS OLAS WAY APT 3504
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2392
Practice Address - Country:US
Practice Address - Phone:914-662-9012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies