Provider Demographics
NPI:1568575439
Name:UPSTATE REGIONAL MEDICAL SUPPLY ,INC.
Entity Type:Organization
Organization Name:UPSTATE REGIONAL MEDICAL SUPPLY ,INC.
Other - Org Name:HEMAN BRACES & ORTHOTICS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-727-6176
Mailing Address - Street 1:1593 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7056
Mailing Address - Country:US
Mailing Address - Phone:585-243-3080
Mailing Address - Fax:585-243-4406
Practice Address - Street 1:1593 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7056
Practice Address - Country:US
Practice Address - Phone:585-243-3080
Practice Address - Fax:585-243-4406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPSTATE REGIONAL MEDICAL SUPPLY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-16
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies