Provider Demographics
NPI:1588637995
Name:AMERICAN VITAL CARE
Entity Type:Organization
Organization Name:AMERICAN VITAL CARE
Other - Org Name:DBA AMERICAN OXYGEN COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-243-0808
Mailing Address - Street 1:1011 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5730
Mailing Address - Country:US
Mailing Address - Phone:631-243-0808
Mailing Address - Fax:800-599-0122
Practice Address - Street 1:1011 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5730
Practice Address - Country:US
Practice Address - Phone:631-243-0808
Practice Address - Fax:800-599-0122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY124939OtherAETNA
NY01357097Medicaid
NYANC1732OtherOXFORD
NY20493OtherVYTRA
NY124939OtherAETNA