Provider Demographics
NPI:1497928766
Name:MIRIAM JUNG - FEELINGS BOUTIQUE
Entity Type:Organization
Organization Name:MIRIAM JUNG - FEELINGS BOUTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-475-0400
Mailing Address - Street 1:285 SILLS RD BLDG 2A
Mailing Address - Street 2:
Mailing Address - City:E PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD BLDG 2A
Practice Address - Street 2:
Practice Address - City:E PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4855
Practice Address - Country:US
Practice Address - Phone:631-475-0400
Practice Address - Fax:631-475-8860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4198560001Medicare NSC