Provider Demographics
NPI:1528399615
Name:UNITED SPINAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:UNITED SPINAL ASSOCIATION, INC.
Other - Org Name:WHEELCHAIR MEDIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KLEO
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-803-3782
Mailing Address - Street 1:7520 ASTORIA BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1177
Mailing Address - Country:US
Mailing Address - Phone:718-803-3782
Mailing Address - Fax:718-803-1089
Practice Address - Street 1:102 DUANE RD
Practice Address - Street 2:
Practice Address - City:FORT TOTTEN
Practice Address - State:NY
Practice Address - Zip Code:11359-1028
Practice Address - Country:US
Practice Address - Phone:718-352-1623
Practice Address - Fax:718-352-3239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED SPINAL ASSOCIATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BC3200X332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
435468OtherJOINT COMMISSION
0142730001Medicare PIN