Provider Demographics
NPI:1467631929
Name:INNOVATIVE PRODUCT SOLUTIONS LLC
Entity Type:Organization
Organization Name:INNOVATIVE PRODUCT SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-846-5099
Mailing Address - Street 1:207 ROCKAWAY TPKE
Mailing Address - Street 2:SUITE#3A
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1216
Mailing Address - Country:US
Mailing Address - Phone:516-612-2583
Mailing Address - Fax:516-612-2584
Practice Address - Street 1:207 ROCKAWAY TPKE
Practice Address - Street 2:SUITE#3A
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1216
Practice Address - Country:US
Practice Address - Phone:516-612-2583
Practice Address - Fax:516-612-2584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6095550001Medicare NSC